Provider Demographics
NPI:1669427670
Name:DEMATTIA, CANDICE MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:MARTIN
Last Name:DEMATTIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:425 HOLDERRIETH BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5189
Mailing Address - Country:US
Mailing Address - Phone:281-475-7599
Mailing Address - Fax:833-973-3832
Practice Address - Street 1:425 HOLDERRIETH BLVD STE 114
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5189
Practice Address - Country:US
Practice Address - Phone:281-475-7599
Practice Address - Fax:833-973-3832
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G4046OtherMEDICARE ID TYPE
TXI49919Medicare UPIN