Individual
DR. MICHAEL TRAE MATTISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
410 N UTICA AVE, LUBBOCK, TX 79416-3035
(806) 776-1098
(806) 771-2078
Mailing address
410 N UTICA AVE, LUBBOCK, TX 79416-3035
(806) 776-1098
(806) 771-2078
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
52120
TN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
K4741
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113365100
FIRSTCARE
TX
05
—
165107702
—
TX
01
—
8K3321
BLUE CROSS BLUE SHIELD
TX
05
—
98574213
—
NM
Enumeration date
08/30/2006
Last updated
02/26/2026
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