Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | Q7744 | TX |
NPI | 1124385638 |
---|---|
Provider Name | Stephen Mathew |
First Address | Waxahachie, TX 75165 |
Second Address | Waxahachie, TX 75165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2012 |
Last Update Date | 27/04/2020 |