Provider Demographics
NPI:1689777286
Name:MATA, HENRY A JR (MD)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:A
Last Name:MATA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:16902 SOUTHWEST FWY
Mailing Address - Street 2:STE 100
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3574
Mailing Address - Country:US
Mailing Address - Phone:281-565-9001
Mailing Address - Fax:281-565-2801
Practice Address - Street 1:16902 SOUTHWEST FWY STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3574
Practice Address - Country:US
Practice Address - Phone:281-565-9001
Practice Address - Fax:281-565-2801
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2024-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK2749207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70637Medicare UPIN
G70637Medicare UPIN