Provider Demographics
NPI:1902837412
Name:PHILIP A MATORIN MD PA
Entity Type:Organization
Organization Name:PHILIP A MATORIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATORIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-920-5558
Mailing Address - Street 1:12121 RICHMOND AVE
Mailing Address - Street 2:SUITE #304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2437
Mailing Address - Country:US
Mailing Address - Phone:281-920-5558
Mailing Address - Fax:281-920-5568
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:SUITE #304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2432
Practice Address - Country:US
Practice Address - Phone:281-920-5558
Practice Address - Fax:281-920-5568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0103207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0008NJOtherBLUE CROSS GROUP ID
TX1208665OtherAETNA
TX183307101Medicaid
TX183307101Medicaid
0008NJOtherBLUE CROSS GROUP ID