Provider Demographics
NPI:1821460239
Name:MATTHEW G. STINE, D.O., P.A.
Entity Type:Organization
Organization Name:MATTHEW G. STINE, D.O., P.A.
Other - Org Name:MEDICAL ASSOCIATES AT WILLOW PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:GORMAN
Authorized Official - Last Name:STINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-441-9252
Mailing Address - Street 1:260 WILLOW BEND DR
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-1188
Mailing Address - Country:US
Mailing Address - Phone:817-441-9252
Mailing Address - Fax:817-441-9282
Practice Address - Street 1:260 WILLOW BEND DR
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-1188
Practice Address - Country:US
Practice Address - Phone:817-441-9252
Practice Address - Fax:817-441-9282
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATTHEW G. STINE, D.O., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-25
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty