=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376677591
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMILE MATHURIN, JR., M.D., P.A.,
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 11/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9810 FM-1960 BYPASS RD W SUITE 115
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-446-4429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5352
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77325-5352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-446-4429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EMILE MATHURIN JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 281-446-4429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | J4907
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------