Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | ME53054 | FL |
NPI | 1104987122 |
---|---|
Provider Name | Dr. Steven Dell Mathews |
First Address | Jacksonville, FL 32216 |
Second Address | Jacksonville, FL 32216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A61161 | (02) |