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General NPI Number Information
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NPI Number | 1033115274
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Entity Type | Individual
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Provider Name | CHARLES R. MATHIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 1001 N WALDROP DR STE 811
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City | ARLINGTON
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State | TX
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Zip | 76012-4715
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Country | US
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Telephone | 817-801-3092
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Fax | 817-801-3110
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Provider Business Mailing Address
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Address Line | 1001 N WALDROP DR STE 811
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City | ARLINGTON
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State | TX
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Zip | 76012-4715
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Country | US
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Telephone | 817-801-3092
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Fax | 817-801-3110
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | J3351
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License Number State | TX
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