Provider Demographics
NPI:1679753016
Name:HOUSTONIAN MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:HOUSTONIAN MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MATOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-680-2611
Mailing Address - Street 1:123 N POST OAK LN
Mailing Address - Street 2:SUITE 420
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-7715
Mailing Address - Country:US
Mailing Address - Phone:713-680-2611
Mailing Address - Fax:713-680-2303
Practice Address - Street 1:123 N POST OAK LN
Practice Address - Street 2:SUITE 420
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-7715
Practice Address - Country:US
Practice Address - Phone:713-680-2611
Practice Address - Fax:713-680-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QW51Medicare PIN