Provider Demographics
NPI:1043212830
Name:MATHEWS, MITZI E (MD)
Entity Type:Individual
Prefix:DR
First Name:MITZI
Middle Name:E
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2609 GLENN HENDREN DRIVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-4205
Mailing Address - Country:US
Mailing Address - Phone:816-781-7730
Mailing Address - Fax:816-415-1886
Practice Address - Street 1:2609 GLENN HENDREN DRIVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-4205
Practice Address - Country:US
Practice Address - Phone:816-781-7730
Practice Address - Fax:816-415-1886
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR4D37207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine