Provider Demographics
NPI:1700842267
Name:MCMENEMY, MATTHEW GRAY (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GRAY
Last Name:MCMENEMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 TOWN CENTER BLVD S
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1285
Mailing Address - Country:US
Mailing Address - Phone:281-277-8400
Mailing Address - Fax:281-277-8408
Practice Address - Street 1:3515 TOWN CENTER BLVD S
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1285
Practice Address - Country:US
Practice Address - Phone:281-277-8400
Practice Address - Fax:281-277-8408
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3604207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136886210Medicaid
TX136886202Medicaid
TX00415YMedicare ID - Type Unspecified
TXC19208Medicare UPIN