Provider Demographics
NPI:1376714519
Name:MATHEWS, SONY (MD)
Entity Type:Individual
Prefix:
First Name:SONY
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:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2213
Mailing Address - Fax:
Practice Address - Street 1:5236 W UNIVERSITY DR
Practice Address - Street 2:SUITE 3300
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7889
Practice Address - Country:US
Practice Address - Phone:972-562-4430
Practice Address - Fax:972-529-2763
Is Sole Proprietor?:No
Enumeration Date:2008-03-16
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002860207R00000X
TX999999207RG0100X
GA065143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC171378OtherMD TRAINING LICENSE
GA065143OtherFULL MD LICENSE
GA002860OtherMD TRAINING LICENSE