Healthcare Provider Details

I. General information

NPI: 1326158700
Provider Name (Legal Business Name): THOMAS A MATHESON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 SAN JACINTO BLVD STE 5 #5
DENTON TX
76205-7531
US

IV. Provider business mailing address

2210 SAN JACINTO BLVD #5
DENTON TX
76205
US

V. Phone/Fax

Practice location:
  • Phone: 940-566-1919
  • Fax: 940-387-5909
Mailing address:
  • Phone: 940-566-1919
  • Fax: 940-387-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1005
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: