Provider Demographics
NPI:1245808856
Name:BLAND, MATTHEW (FNP)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:BLAND
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5000 ELDORADO PKWY
Mailing Address - Street 2:BOX 150-153
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-8695
Mailing Address - Country:US
Mailing Address - Phone:214-733-7578
Mailing Address - Fax:972-637-9272
Practice Address - Street 1:5000 ELDORADO PKWY STE 420
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-8612
Practice Address - Country:US
Practice Address - Phone:469-598-1200
Practice Address - Fax:972-637-9272
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX859357207Q00000X
TX1024504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty