Provider Demographics
NPI:1437340627
Name:MATHERS, CHARLES HOOD (MD, MPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HOOD
Last Name:MATHERS
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1110
Mailing Address - Country:US
Mailing Address - Phone:409-747-6131
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1110
Practice Address - Country:US
Practice Address - Phone:409-747-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5228207R00000X, 2083A0100X
AZ457062083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4651659743OtherMYUTMB 4651659743
AZ686600Medicaid
AZZ152891Medicare PIN