Provider Demographics
NPI:1922005396
Name:MATTHEWS, GEORGE PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:PHILIP
Last Name:MATTHEWS
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 1:1325 PENNSYLVANIA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2146
Mailing Address - Country:US
Mailing Address - Phone:877-683-3702
Mailing Address - Fax:469-484-6415
Practice Address - Street 1:1325 PENNSYLVANIA AVE STE 110
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2146
Practice Address - Country:US
Practice Address - Phone:877-683-3702
Practice Address - Fax:469-484-6415
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0122174400000X, 207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116714007Medicaid
TX116714005Medicaid
TX116714006Medicaid
TX116714001Medicaid
TX116714003Medicaid
TX116714001Medicaid
TX116714006Medicaid
TX116714007Medicaid
TX80E665Medicare PIN
TX116714003Medicaid
TX8L12743Medicare PIN