Provider Demographics
NPI:1679572671
Name:DOUGLAS A. MATEY, JR., M.D., P.A.
Entity Type:Organization
Organization Name:DOUGLAS A. MATEY, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:830-792-6860
Mailing Address - Street 1:PO BOX 291411
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-1411
Mailing Address - Country:US
Mailing Address - Phone:830-792-6860
Mailing Address - Fax:830-792-3738
Practice Address - Street 1:1331 BANDERA HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-9515
Practice Address - Country:US
Practice Address - Phone:830-792-6860
Practice Address - Fax:830-792-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0039LMOtherBLUE CROSS/BLUE SHEILD
TX0039LMOtherBLUE CROSS/BLUE SHEILD
TX00717WMedicare ID - Type Unspecified