| Doctor Name: | DR. MATTHEW DRISCOLL |
| NPI Number: | 1437307592 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | BP10031393 |
| Business Practice Address: | 1301 W 38th St Ste 102 Austin, TX - 787051010 |
| Business Phone Number: | 5124544561 |
| Business Fax Number: | 5124067330 |
| Mailing Address: | 4515 Seton Center Pkwy, Suite 215-credentialing AUSTIN |
| State: | TX |
| Postal Code: | 787595290 |
| Phone Number: | 5122315548 |
| Fax Number: | 5124066216 |
| NPI Enumeration Date: | 09/03/2008 |
| NPI Last Update Date: | 03/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | BP10031393 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |