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NPI Code Detail

MEDICARE: PETER MATHERN M.D.

MEDICARE: PETER MATHERN 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
1207RH0003XHematology & Oncology Physician24332AZ
2207RX0202XMedical Oncology Physician24332AZ

Other Identifiers

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

General Provider Information

NPI Number : 1316995699
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER MATHERN M.D.
Provider Business Mailing Address
First Line : PO BOX 749495
Second Line :
City : ATLANTA
State : GA
Zip : 30374-9495
Country : US
Telephone Number : 855-963-2100
Fax Number : 813-321-1296
Provider Business Practice Location Address
First Line : 77 W FOREST AVE
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86001-1479
Country : US
Telephone Number : 928-635-7307
Fax Number : 928-774-3844
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 03/09/2026

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