Basic Information
| Provider Information | |||||||||
| NPI: | 1396008124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUMAN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 844658 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752844658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547242111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 239 W BUSINESS 190 | ||||||||
| Address2: | |||||||||
| City: | COPPERAS COVE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765222912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545429000 | ||||||||
| FaxNumber: | 2545429001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01073792A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | S4595 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01512378 | 01 | IN | RR MEDICARE | OTHER | 201113260 | 05 | IN | MEDICAID |