Basic Information
| Provider Information | |||||||||
| NPI: | 1679816284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKERLEY | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | RAMIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1204 BARLOW BND | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760929608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158120861 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7777 FOREST LN | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752302571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725667000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2013 | ||||||||
| LastUpdateDate: | 06/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | Q7235 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.