Provider Demographics
NPI:1205194537
Name:MATHEWS, MICHAEL RICHARD II (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:MATHEWS
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5129
Mailing Address - Country:US
Mailing Address - Phone:830-379-5867
Mailing Address - Fax:830-401-4035
Practice Address - Street 1:1215 E COURT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5129
Practice Address - Country:US
Practice Address - Phone:830-379-5867
Practice Address - Fax:830-401-4035
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121459367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX332798302Medicaid
TXP01746189OtherRR MEDICARE
TX8635UMOtherBCBS
TX8635UMOtherBCBS