Provider Demographics
NPI:1871595496
Name:PHILLIPS, MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7800 SHOAL CREEK BLVD SUITE 205N
Mailing Address - Street 2:AUSTIN HEART, PLLC
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757
Mailing Address - Country:US
Mailing Address - Phone:512-206-4341
Mailing Address - Fax:512-206-4350
Practice Address - Street 1:800 W CENTRAL TEXAS EXPY
Practice Address - Street 2:STE. 355
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1899
Practice Address - Country:US
Practice Address - Phone:254-526-2085
Practice Address - Fax:254-526-9569
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2015-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK1897207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1177164-03Medicaid
TX1177164-04Medicaid
D91482Medicare UPIN
TX8827M3Medicare PIN