Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | L3745 | TX |
NPI | 1225033350 |
---|---|
Provider Name | Dr. James E Mathis |
First Address | Tomball, TX 77375-6410 |
Second Address | Tomball, TX 77375-6410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 03/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
158829501 | (05) | TX |
H73045 | (02) | TX |