Basic Information
| Provider Information | |||||||||
| NPI: | 1649213158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTHEWS | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9724379605 | ||||||||
| Practice Location | |||||||||
| Address1: | 3410 WORTH ST | ||||||||
| Address2: | DEPT OF GYNECOLOGIC ONCOLOGY | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752462044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143701301 | ||||||||
| FaxNumber: | 2143701318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 03/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | H7786 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 100221480A | 05 | OK | MEDICAID | 000V7922 | 05 | NM | MEDICAID | 139789507 | 05 | TX | MEDICAID | 139789508 | 05 | TX | MEDICAID | 139789511 | 05 | TX | MEDICAID | 139789519 | 05 | TX | MEDICAID | 139789520 | 05 | TX | MEDICAID | 8R1498 | 01 | TX | BLUE CROSS OF TX | OTHER | 139789503 | 05 | TX | MEDICAID | 139789506 | 05 | TX | MEDICAID | 139789501 | 05 | TX | MEDICAID | 139789502 | 05 | TX | MEDICAID | 139789509 | 05 | TX | MEDICAID | 139789505 | 05 | TX | MEDICAID |