Individual
MATTHEW MURRAY TILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(800) 994-0371
(254) 215-9722
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
565310
TX
208600000X
Surgery Physician
Primary
R9004
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
392355901
—
TX
01
—
392355902
MEDICAID CSHCN
TX
Enumeration date
06/03/2012
Last updated
08/02/2023
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