MEDICARE: DR. NAOMI ELIZABETH MATHEW 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	207R00000X	Internal Medicine Physician	4301097145	MI
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	Q9435	TX
3	207RP1001X	Pulmonary Disease Physician	Q9435	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	861926	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8LQ106	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376857292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAOMI ELIZABETH MATHEW M.D.

Provider Business Mailing Address
First Line	:	804 COPPER RIDGE LOOP
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-5099
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 W CENTRAL TEXAS EXPY
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1890
Country	:	US
Telephone Number	:	254-618-1090
Fax Number	:

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

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	12/09/2019

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