Basic Information
| Provider Information | |||||||||
| NPI: | 1497971345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DACSO | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 CHELSEA ST | ||||||||
| Address2: | |||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774015007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014448450 | ||||||||
| FaxNumber: | 4014445088 | ||||||||
| Practice Location | |||||||||
| Address1: | UTMB UHC FL 4 | ||||||||
| Address2: | 301 UNIVERSITY BLVD. | ||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775550001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014448450 | ||||||||
| FaxNumber: | 4014445088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 02/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N3594 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.