Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME82734 | FL |
NPI | 1003961103 |
---|---|
Provider Name | Dr. Chacko P. Mathews |
First Address | Palm Springs, FL 33461-2175 |
Second Address | Palm Springs, FL 33461-2175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 11/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
#C53871 | (02) | FL |