Individual
MATTHEW TICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12221 MERIT DR, SUITE 1500, DALLAS, TX 75251-2202
(214) 217-1911
Mailing address
12221 MERIT DR, SUITE 1500, DALLAS, TX 75251-2202
(214) 217-1911
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
Q8371
TX
207P00000X
Emergency Medicine Physician
TRN17251
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014953600
—
FL
Enumeration date
05/08/2012
Last updated
11/29/2016
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