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NPI Code Detail

MEDICARE: DR. JASON EARL MATHERNE M.D.

MEDICARE: DR. JASON EARL 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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianL3744TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4N0123265OTHERTXDPS
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679670681
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON EARL MATHERNE M.D.
Provider Business Mailing Address
First Line : 3530 FANNIN ST
Second Line :
City : BEAUMONT
State : TX
Zip : 77701-3805
Country : US
Telephone Number : 409-842-8222
Fax Number : 409-842-8244
Provider Business Practice Location Address
First Line : 3530 FANNIN ST
Second Line :
City : BEAUMONT
State : TX
Zip : 77701-3805
Country : US
Telephone Number : 409-842-8222
Fax Number : 409-842-8244
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 12/16/2011

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