Basic Information
Provider Information
NPI: 1003297607
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: UY
FirstName: MATTHEW
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3131 MCINDOE RD
Address2:  
City: JBSA - FT SAM HOUSTON
State: TX
PostalCode: 78234
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3551 ROGER BROOKE DR
Address2:  
City: FORT SAM HOUSTON
State: TX
PostalCode: 78234
CountryCode: US
TelephoneNumber: 2109164141
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/09/2015
LastUpdateDate: 06/05/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000X34.012373OHN Allopathic & Osteopathic PhysiciansGeneral Practice 
390200000X34.012373OHY Student, Health CareStudent in an Organized Health Care Education/Training Program 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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