Provider Demographics
NPI:1134304140
Name:MATHENY, GARY LANCE II (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LANCE
Last Name:MATHENY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 FOUNTAIN SQ
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-1307
Mailing Address - Country:US
Mailing Address - Phone:423-294-4132
Mailing Address - Fax:423-763-9892
Practice Address - Street 1:1 FOUNTAIN SQ
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-1307
Practice Address - Country:US
Practice Address - Phone:423-294-4132
Practice Address - Fax:423-763-9892
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN31578207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E19542Medicare UPIN