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NPI Code Detail

MEDICARE: PAUL MATHERNE, M.D.

MEDICARE: PAUL MATHERNE, 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
1305R00000XPreferred Provider Organization09445MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2437709303OTHERMSBCBS OF MS/ BCBS OF ALA.

General Provider Information

NPI Number : 1659479210
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAUL MATHERNE, M.D.
Provider Business Mailing Address
First Line : 180B DEBUYS RD
Second Line : SUITE #223
City : BILOXI
State : MS
Zip : 39531-4404
Country : US
Telephone Number : 228-388-4862
Fax Number : 228-388-2556
Provider Business Practice Location Address
First Line : 180B DEBUYS RD
Second Line : SUITE #223
City : BILOXI
State : MS
Zip : 39531-4404
Country : US
Telephone Number : 228-388-4862
Fax Number : 228-388-2556
Authorized Official
Title or Position : OWNER/SOLO
Name : DR. PAUL G. MATHERNE
Credential : M.D.
Telephone Number : 228-388-4862
Provider Enumeration Date : 09/20/2006
Last Update Date : 12/08/2015

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