Matthew Howard Boutte, PA-C, MPAS
Individual provider Active NPI Physician Assistant · Brenham, TX
NPI 1457589558 · NPPES record last updated Jun 4, 2015
Key facts
- NPI
- 1457589558
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA09060 (TX)
- Practice address
- 700 Medical Pkwy
Brenham, TX 77833-5413 - Phone
- (979) 337-5000
- NPI assigned
- Jun 26, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA09060 | TX | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MA053903 | PA | |
| Physician Assistant | 363A00000X | PA09060 | TX | Yes |
Addresses
Primary practice location
700 Medical Pkwy
Brenham, TX 77833-5413
Mailing address
PO Box 844658
Dallas, TX 75284-4658
Phone (254) 724-2111
Other providers in Brenham, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.