Provider Demographics
NPI:1255993879
Name:WOODWORTH, MATTHEW AARON (NP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:WOODWORTH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10541 MUSTANG WELLS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-6461
Mailing Address - Country:US
Mailing Address - Phone:817-733-1317
Mailing Address - Fax:
Practice Address - Street 1:12300 BEAR PLZ STE 408
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-9501
Practice Address - Country:US
Practice Address - Phone:817-585-1768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140285207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine