Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 21183 | OK |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 21183 | OK |
NPI | 1154398352 |
---|---|
Provider Name | Migy K Mathew |
First Address | Oklahoma City, OK 73104 |
Second Address | Oklahoma City, OK 73104-5007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 06/03/2009 |