Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | L7034 | TX |
Y | 207RP1001X | Pulmonary Disease | L7034 | TX |
N | 207RS0012X | Sleep Medicine | L7034 | TX |
NPI | 1083602080 |
---|---|
Provider Name | Jefy M Mathew |
First Address | Kingwood, TX 77339-6009 |
Second Address | The Woodlands, TX 77380-3240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 01/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160208801 | (05) | TX |
16028802 | (05) | TX |
H91207 | (02) | TX |