Healthcare Provider Details

I. General information

NPI: 1154499051
Provider Name (Legal Business Name): J. KYLE MATHEWS M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 MIDWAY RD SUITE 210 OR 200
PLANO TX
75093-6383
US

IV. Provider business mailing address

3108 MIDWAY RD SUITE 210 OR 200
PLANO TX
75093-6383
US

V. Phone/Fax

Practice location:
  • Phone: 972-781-1444
  • Fax: 972-781-1448
Mailing address:
  • Phone: 972-781-1444
  • Fax: 972-781-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberH6415
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberH6415
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberH6415
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberH6415
License Number StateTX

VIII. Authorized Official

Name: J KYLE MATHEWS
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 972-781-1444