Provider Demographics
NPI:1538162912
Name:MATYAS, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MATYAS
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 1:8020 CONSTITUTION PL NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7607
Mailing Address - Country:US
Mailing Address - Phone:505-998-3096
Mailing Address - Fax:505-998-3100
Practice Address - Street 1:8020 CONSTITUTION PL NE
Practice Address - Street 2:SUITE 202
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7607
Practice Address - Country:US
Practice Address - Phone:505-998-3096
Practice Address - Fax:505-998-3100
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH82412085R0202X
NMMD2013-02882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM293460YLGQOtherMEDICARE
TX118189304Medicaid
NM293460YN90OtherMEDICARE
TX118189304Medicaid