Provider Demographics
NPI:1750432688
Name:MATTHEWS, JONATHAN RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RICHARD
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:300 TROPHY CLUB DR
Mailing Address - Street 2:STE 600
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3401
Mailing Address - Country:US
Mailing Address - Phone:817-490-9841
Mailing Address - Fax:817-490-9841
Practice Address - Street 1:300 TROPHY CLUB DR
Practice Address - Street 2:SUITE 300
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5415
Practice Address - Country:US
Practice Address - Phone:817-490-9841
Practice Address - Fax:817-490-9838
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X2575OtherBCBS
TX188312601Medicaid
TX8J4863Medicare PIN
TX188312601Medicaid