Provider Demographics
NPI:1023529955
Name:SOOUDI, MATTHEW M
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:SOOUDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4621
Mailing Address - Country:US
Mailing Address - Phone:409-201-7040
Mailing Address - Fax:
Practice Address - Street 1:980 THOMAS RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-4621
Practice Address - Country:US
Practice Address - Phone:409-201-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0663208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery