Provider Demographics
NPI:1861573800
Name:CARRICK, MATTHEW M (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:CARRICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 GREENWAY PLZ
Mailing Address - Street 2:SUITE 910
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0297
Mailing Address - Country:US
Mailing Address - Phone:713-798-1750
Mailing Address - Fax:713-798-1144
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-8890
Practice Address - Fax:713-873-8898
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL7679208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C1188Medicare PIN
I11338Medicare UPIN