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General NPI Number Information
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NPI Number | 1063401701
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Entity Type | Organization
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Legal Business Name | MARION J MATHEWS MD PA
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Dates
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Enumeration Date | 10/16/2005
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 114 AIRPORT RD STE C
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City | PANAMA CITY
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State | FL
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Zip | 32405-4738
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Country | US
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Telephone | 850-769-6105
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Fax |
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Provider Business Mailing Address
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Address Line | 2655 FEROL LN
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City | LYNN HAVEN
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State | FL
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Zip | 32444-3213
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Country | US
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Telephone | 850-769-6105
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARION J MATHEWS
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Credential | MD
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Telephone | 850-769-6105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME26212
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License Number State | FL
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