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NPI Code Detail

MEDICARE: JAMES GLENN MATTHEWS

MEDICARE: JAMES GLENN MATTHEWS
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
1175T00000XPeer Specialist1215150644OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1V083161617OTHEROKDRIVER ID

General Provider Information

NPI Number : 1184222309
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES GLENN MATTHEWS
Provider Business Mailing Address
First Line : 1201 W WALLACE DR
Second Line :
City : ENID
State : OK
Zip : 73703-7912
Country : US
Telephone Number : 580-231-8915
Fax Number :
Provider Business Practice Location Address
First Line : 1824 S VAN BUREN ST
Second Line :
City : ENID
State : OK
Zip : 73703-7903
Country : US
Telephone Number : 405-230-1181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2020
Last Update Date : 10/09/2020

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