MEDICARE: DR. GARY LANCE MATHENY II M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	31578	TN

General Provider Information

NPI Number	:	1134304140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY LANCE MATHENY II M.D.

Provider Business Mailing Address
First Line	:	1 FOUNTAIN SQ
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-1307
Country	:	US
Telephone Number	:	423-294-4132
Fax Number	:	423-763-9892

Provider Business Practice Location Address
First Line	:	1 FOUNTAIN SQ
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-1307
Country	:	US
Telephone Number	:	423-294-4132
Fax Number	:	423-763-9892

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	01/09/2008

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