MEDICARE: JACK M. MATHENY II, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184671844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACK M. MATHENY II, M.D.

Provider Business Mailing Address
First Line	:	205 ZEAGLER DR
Second Line	:	STE 101
City	:	PALATKA
State	:	FL
Zip	:	32177-3888
Country	:	US
Telephone Number	:	328-328-6746
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 ZEAGLER DR STE 10
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-3826
Country	:	US
Telephone Number	:	328-328-6746
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACK MEADOWS MATHENY II
Credential	:	M.D.
Telephone Number	:	386-328-6746

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	09/12/2024

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Directions to “JACK M. MATHENY II, M.D. ” Practice Location

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