Provider Demographics
NPI:1811337439
Name:MATZEN, DORIAN R (DO)
Entity type:Individual
Prefix:MR
First Name:DORIAN
Middle Name:R
Last Name:MATZEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DORIAN
Other - Middle Name:R
Other - Last Name:MATTINGLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-6965
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:4510 BELL ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5714
Practice Address - Country:US
Practice Address - Phone:806-212-4835
Practice Address - Fax:806-212-0900
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9436207Q00000X
KY04927207R00000X, 208M00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360140301Medicaid
TX518220YM5UMedicare UPIN