Healthcare Provider Details

I. General information

NPI: 1639123177
Provider Name (Legal Business Name): VARGHESE E MATHAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 CARLTON ST
WAUCHULA FL
33873-3407
US

IV. Provider business mailing address

7609 CAMDEN HARBOUR DR
BRADENTON FL
34212-9305
US

V. Phone/Fax

Practice location:
  • Phone: 863-767-8270
  • Fax:
Mailing address:
  • Phone: 941-745-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME67514
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: