Basic Information
| Provider Information | |||||||||
| NPI: | 1861820946 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COSTON | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | JASON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1102 BARCLAY ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782077161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102337000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1102 BARCLAY ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782077161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102337000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2013 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 207Q00000X | BP10079369 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.