Provider Demographics
NPI:1346457751
Name:MATHEWS, MANU (MD)
Entity Type:Individual
Prefix:DR
First Name:MANU
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 WESTERN CENTER BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1938
Mailing Address - Country:US
Mailing Address - Phone:817-381-9650
Mailing Address - Fax:817-585-5836
Practice Address - Street 1:3345 WESTERN CENTER BLVD STE 160
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1938
Practice Address - Country:US
Practice Address - Phone:817-381-9650
Practice Address - Fax:817-585-5836
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0897412084P0800X, 2084P2900X
TXQ1450208VP0000X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine