Provider Demographics
NPI:1316069990
Name:IVEY, MATTHEW S (DPM)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:IVEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 PARKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3425
Mailing Address - Country:US
Mailing Address - Phone:713-979-3343
Mailing Address - Fax:855-592-3269
Practice Address - Street 1:1602 PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3425
Practice Address - Country:US
Practice Address - Phone:713-979-3343
Practice Address - Fax:855-592-3269
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1825213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188879403Medicaid
TX188879405Medicaid
TX188879401Medicaid
TXP01026742OtherRAILROAD MEDICARE
TX188879402Medicaid
TX8G9747OtherBCBS PIN
TX188879404Medicaid
TXTXB143858Medicare PIN
TX8G9747OtherBCBS PIN
TX188879405Medicaid
TXTXB143861Medicare PIN
TXTXB143713Medicare PIN