MEDICARE: RENEE MARY MATHEW PA-C

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	363A00000X	Physician Assistant	PA06982	TX

General Provider Information

NPI Number	:	1174826606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE MARY MATHEW PA-C

Provider Business Mailing Address
First Line	:	7777 FOREST LN STE C135
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-6825
Country	:	US
Telephone Number	:	972-347-4783
Fax Number	:	972-347-4916

Provider Business Practice Location Address
First Line	:	7777 FOREST LN STE C135
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-6825
Country	:	US
Telephone Number	:	972-347-4783
Fax Number	:	972-347-4916

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

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	05/28/2026

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