Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 249874 | NY |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 38604 | IA |
NPI | 1003053653 |
---|---|
Provider Name | Dr. Stanley John Mathew |
First Address | Cedar Rapids, IA 52402-5036 |
Second Address | Cedar Rapids, IA 52402-5036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2009 |
Last Update Date | 07/11/2011 |