Provider Demographics
NPI:1336184845
Name:MATT T. GUBERT, PA
Entity Type:Organization
Organization Name:MATT T. GUBERT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:T
Authorized Official - Last Name:GUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-588-4541
Mailing Address - Street 1:PO BOX 224801
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-4801
Mailing Address - Country:US
Mailing Address - Phone:972-588-4541
Mailing Address - Fax:469-304-0139
Practice Address - Street 1:400 CHISHOLM PL STE 114
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6957
Practice Address - Country:US
Practice Address - Phone:972-588-4541
Practice Address - Fax:469-304-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00696ZMedicare PIN
TX00695ZMedicare PIN