Provider Demographics
NPI:1346244779
Name:MATTAX, JAMES B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:MATTAX
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1265 E PRIMROSE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4278
Mailing Address - Country:US
Mailing Address - Phone:417-886-3937
Mailing Address - Fax:417-886-1825
Practice Address - Street 1:1265 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4278
Practice Address - Country:US
Practice Address - Phone:417-886-3937
Practice Address - Fax:417-886-1285
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-07-01
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Provider Licenses
StateLicense IDTaxonomies
MOR9H41207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202545034Medicaid
MO202545026Medicaid
MO0840001OtherUNITED HC OF MIDWEST
MO32245OtherOPTICARE
MO118132OtherBLUE CROSS/SHIELD ST.LOU
MO822629OtherHEALTHCARE PREFERRED
MO1402OtherCOX HEALTH INS