Provider Demographics
NPI:1831187889
Name:MATSU, EDDIE TATSUO (MD)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:TATSUO
Last Name:MATSU
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 1:1201 BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3835
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:
Practice Address - Street 1:1201 BROOKS ST
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3835
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3060207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134233910Medicaid
TX610119705OtherUS DEPT OF LABOR
TXP00777068OtherMEDICARE RAILROAD
TX134233909Medicaid
TXP01142161OtherRR MEDICARE
TX134233908Medicaid
TX134233911Medicaid
TX8BP176OtherBLUE CROSS BLUE SHIELD
TX134233910Medicaid
TXP00777068OtherMEDICARE RAILROAD
TXP01142161OtherRR MEDICARE
TXC18953Medicare UPIN
TX134233909Medicaid
TX8L13320Medicare PIN