Provider Demographics
NPI:1710932140
Name:SHUFORD, MATTHEW DAWSON (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAWSON
Last Name:SHUFORD
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 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:3417 GASTON AVE
Practice Address - Street 2:SUITE 830
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-0830
Practice Address - Country:US
Practice Address - Phone:214-826-6021
Practice Address - Fax:214-823-9745
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0918208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00254305OtherRRMCR
TX8M6733OtherBCBS
TX175130701Medicaid
TXP00254305OtherRRMCR
I34607Medicare UPIN
TX175130701Medicaid