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General NPI Number Information
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NPI Number | 1043381809
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Entity Type | Individual
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Provider Name | JAMES WALLACE MATHEWSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1330 N RIM DR SUITE A
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3134
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Country | US
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Telephone | 928-779-7014
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Fax |
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Provider Business Mailing Address
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Address Line | 6404 E SETTLERS RUN RD
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-7216
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Country | US
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Telephone | 858-395-8652
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G29338
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | G29338
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License Number State | CA
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