Provider Demographics
NPI:1649230145
Name:MATHEWS, ARUN (MD)
Entity Type:Individual
Prefix:
First Name:ARUN
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 1:400 W 4TH ST
Mailing Address - Street 2:MCH CMIO OFFICE
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5045
Mailing Address - Country:US
Mailing Address - Phone:432-640-2408
Mailing Address - Fax:432-640-4606
Practice Address - Street 1:500 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5001
Practice Address - Country:US
Practice Address - Phone:432-640-2834
Practice Address - Fax:432-640-2897
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20050505207R00000X
TXN2188207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM97431201OtherHOBBS AHCCCS
NM79285864Medicaid
NMP00268426OtherRAILROAD MEDICARE
NMNM009X13OtherBLUE CROSS BLUE SHIELD
NM79285864Medicaid
NMP00268426OtherRAILROAD MEDICARE
NMI47376Medicare UPIN