Provider Demographics
NPI:1720072358
Name:LOEWEN, MATT L (DO)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:L
Last Name:LOEWEN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6640
Mailing Address - Country:US
Mailing Address - Phone:956-854-4260
Mailing Address - Fax:956-854-4266
Practice Address - Street 1:1600 N WESTGATE DR STE 800
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4952
Practice Address - Country:US
Practice Address - Phone:956-854-4260
Practice Address - Fax:956-854-4266
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3026208D00000X, 207Q00000X
OK2290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133831110Medicaid
TX8F24345OtherMEDICARE - INDIVIDUAL
TX0A6188OtherMEDICARE- GROUP