# IGOR EVAN MATWIJIW

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1114911369
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | J4910 | TX | Yes |

## Other

- **Enumeration date:** 09/02/2005
- **Last updated:** 06/22/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 126488902 | — | TX |
| 05 | — | 126488906 | — | TX |
| 05 | — | 200298690A | — | OK |
| 01 | — | 4321815 | AETNA | TX |
| 01 | — | 460002032 | RAILROAD MEDICARE | TX |
| 01 | — | 87281J | BCBS | TX |
| 01 | — | 87592Z | HMO BLUE | TX |