Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 41216 | AZ |
NPI | 1013176981 |
---|---|
Provider Name | Dr. Mathew P Cherian |
First Address | Gulfport, FL 33707-3969 |
Second Address | Gulfport, FL 33707-3969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 30/09/2009 |