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Individual
MATTHEW V LAND
Active
Individual
MATTHEW V LAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04590
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187968602
—
TX
05
—
187968603
—
TX
01
—
75-2616977-091
TRICARE
TX
01
—
8EY674
BCBS
TX
01
—
P00430280
RR MEDICARE
TX
01
—
P01583815
RAIL ROAD MEDICARE
TX
Enumeration date
05/19/2006
Last updated
02/29/2016
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