Provider Demographics
NPI:1629060900
Name:MATHESON, DONALD MILLS (MD)
Entity Type:Individual
Prefix:MISS
First Name:DONALD
Middle Name:MILLS
Last Name:MATHESON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1245 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-4305
Mailing Address - Country:US
Mailing Address - Phone:707-459-6861
Mailing Address - Fax:707-459-3057
Practice Address - Street 1:1245 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-4305
Practice Address - Country:US
Practice Address - Phone:707-459-6861
Practice Address - Fax:707-459-3057
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG25745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42782Medicare UPIN