Healthcare Provider Details

I. General information

NPI: 1891860383
Provider Name (Legal Business Name): KATHERINE J MATHEWS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 BELLEVUE AVE STE 205
SAINT LOUIS MO
63117-1851
US

IV. Provider business mailing address

5535 DELMAR BOULEVARD
ST LOUIS MO
63112
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-8730
  • Fax:
Mailing address:
  • Phone: 314-879-6363
  • Fax: 314-879-6486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number115532
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: