Healthcare Provider Details

I. General information

NPI: 1043381809
Provider Name (Legal Business Name): JAMES WALLACE MATHEWSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N RIM DR SUITE A
FLAGSTAFF AZ
86001-3134
US

IV. Provider business mailing address

6404 E SETTLERS RUN RD
FLAGSTAFF AZ
86004-7216
US

V. Phone/Fax

Practice location:
  • Phone: 928-779-7014
  • Fax:
Mailing address:
  • Phone: 858-395-8652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG29338
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberG29338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: