Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MT 185032 | PA |
N | 208600000X | Surgeon | MT 185032 | PA |
N | 208200000X | Surgeon | MT185032 | PA |
N | 208600000X | Surgeon | MT185032 | PA |
Y | 2086S0105X | Surgery of the Hand | N5229 | TX |
NPI | 1588857874 |
---|---|
Provider Name | Mr. John William Mathewson |
First Address | Midland, TX 79706-2707 |
Second Address | Midland, TX 79706-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 08/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
380896601 | (05) | TX |
N5229 | STATE LICENSE (01) | TX |