Provider Demographics
NPI:1326158700
Name:MATHESON, THOMAS A (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:MATHESON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2210 SAN JACINTO BLVD
Mailing Address - Street 2:#5
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205
Mailing Address - Country:US
Mailing Address - Phone:940-566-1919
Mailing Address - Fax:940-387-5909
Practice Address - Street 1:2210 SAN JACINTO BLVD STE 5
Practice Address - Street 2:#5
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7531
Practice Address - Country:US
Practice Address - Phone:940-566-1919
Practice Address - Fax:940-387-5909
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1005213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018803901Medicaid
T14638Medicare UPIN
TX00QH75Medicare ID - Type Unspecified