Provider Demographics
NPI:1174515787
Name:ROCKETT, MATTHEW S (DPM)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:ROCKETT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-488-3237
Mailing Address - Fax:281-488-4218
Practice Address - Street 1:1234 BAY AREA BLVD STE G
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2538
Practice Address - Country:US
Practice Address - Phone:281-488-3237
Practice Address - Fax:281-488-4218
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1300213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104821701Medicaid
U61497Medicare UPIN
TX85V953Medicare ID - Type Unspecified