Individual
IGOR EVAN MATWIJIW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2602 SAINT MICHAEL DR STE 201B, TEXARKANA, TX 75503-2320
(903) 614-5530
Mailing address
919 HIDDEN RDG, IRVING, TX 75038-3813
(469) 282-2711
(469) 282-0996
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
J4910
TX
Other
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
Enumeration date
09/02/2005
Last updated
06/22/2021
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