MEDICARE: GRANT MATHEWS MD

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	E-5332	AR
2	207RN0300X	Nephrology Physician	E-5332	AR

General Provider Information

NPI Number	:	1689898843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT MATHEWS MD

Provider Business Mailing Address
First Line	:	555 W 6TH ST
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-3409
Country	:	US
Telephone Number	:	870-425-1787
Fax Number	:	870-425-2009

Provider Business Practice Location Address
First Line	:	555 WEST 6TH ST
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-3207
Country	:	US
Telephone Number	:	870-425-1787
Fax Number	:	870-425-2009

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	10/16/2013

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