Provider Demographics
NPI:1033158134
Name:MATHEWS, THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17221 E 23RD ST S
Mailing Address - Street 2:SUITE #300
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1803
Mailing Address - Country:US
Mailing Address - Phone:816-373-8822
Mailing Address - Fax:816-373-8885
Practice Address - Street 1:17221 E 23RD ST S
Practice Address - Street 2:SUITE #300
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1803
Practice Address - Country:US
Practice Address - Phone:816-373-8822
Practice Address - Fax:816-373-8885
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002000629207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D79007Medicare UPIN
230B563Medicare ID - Type Unspecified