Provider Demographics
NPI:1689630188
Name:MATHEWS, JOHN LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LOUIS
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 1:917 TUSCALOOSA AVE SW
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1618
Mailing Address - Country:US
Mailing Address - Phone:205-780-7150
Mailing Address - Fax:205-783-9326
Practice Address - Street 1:917 TUSCALOOSA AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1618
Practice Address - Country:US
Practice Address - Phone:205-780-7150
Practice Address - Fax:205-783-9326
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8477208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10325Medicaid
AL51010325OtherBC/BS
AL0000010325Medicare NSC
AL51010325OtherBC/BS
AL10325Medicaid
AL000010325Medicare PIN