Individual
DAVID MATTHEW ISLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M D
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-4500
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
M4195
TX
207L00000X
Anesthesiology Physician
TX TEMP LICENSE
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181296601
—
TX
01
—
P00326015
RAILROAD MEDICARE
TX
Enumeration date
06/13/2006
Last updated
10/13/2014
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