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General NPI Number Information
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NPI Number | 1629198544
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Entity Type | Organization
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Legal Business Name | JACK M. MATHENY II, MD
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 700 ZEAGLER DR STE 10
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City | PALATKA
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State | FL
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Zip | 32177-3826
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Country | US
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Telephone | 386-328-6746
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Fax | 386-328-7554
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Provider Business Mailing Address
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Address Line | 700 ZEAGLER DR STE 10
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City | PALATKA
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State | FL
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Zip | 32177-3826
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Country | US
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Telephone | 386-328-6746
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Fax | 386-328-7554
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | SATISH RAVI
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Credential | MD
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Telephone | 386-328-6746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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