Provider Demographics
NPI:1134289994
Name:HUMMELL, MATTHEW K (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
Last Name:HUMMELL
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 1:801 W 38TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1167
Mailing Address - Country:US
Mailing Address - Phone:512-306-1323
Mailing Address - Fax:512-306-1142
Practice Address - Street 1:801 W 38TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1167
Practice Address - Country:US
Practice Address - Phone:512-306-1323
Practice Address - Fax:512-306-1142
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3821207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140005921OtherMEDICARE RAIL ROAD
TXP000J64J8Medicaid
TX89733FOtherBLUE CROSS BLUE SHIELD
TX130428906OtherTPI
TX4241071OtherAETNA
TX130428906OtherTPI
TX140005921OtherMEDICARE RAIL ROAD