Provider Demographics
NPI:1619980919
Name:MATHEWS, GEORGE W (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3011
Mailing Address - Country:US
Mailing Address - Phone:417-754-2223
Mailing Address - Fax:417-754-8046
Practice Address - Street 1:201 S ARTHUR ST
Practice Address - Street 2:
Practice Address - City:HUMANSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65674-8400
Practice Address - Country:US
Practice Address - Phone:417-754-2223
Practice Address - Fax:417-754-8046
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODOR7A99207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10366Medicare UPIN
MO020013888Medicare PIN