Provider Demographics
NPI:1588667778
Name:MATHURIN, EMILE JR (MD)
Entity Type:Individual
Prefix:
First Name:EMILE
Middle Name:
Last Name:MATHURIN
Suffix:JR
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 5352
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77325-5352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9810 FM-1960 BYPASS RD. W.
Practice Address - Street 2:STE 115
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338
Practice Address - Country:US
Practice Address - Phone:713-691-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4907208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182746300OtherFEDERAL WORKERS COMP
TX4573189OtherAETNA
TX250007825OtherRAIL ROAD MEDICARE
TX126596906Medicaid
8AJ843OtherBC/BS
TXE62495Medicare UPIN
TX250007825OtherRAIL ROAD MEDICARE