Provider Demographics
NPI:1770755548
Name:FLETCHER, MATTHEW B (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE D400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6899
Practice Address - Country:US
Practice Address - Phone:972-566-6647
Practice Address - Fax:972-566-6496
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2045322080P0207X
TXU14942080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2150138Medicaid
MS06400061Medicaid
LA2150138Medicaid