Provider Demographics
NPI:1740403120
Name:ROY J MATHEW MDPA
Entity Type:Organization
Organization Name:ROY J MATHEW MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-617-3855
Mailing Address - Street 1:6810 ISLAND CIR # 1
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-1413
Mailing Address - Country:US
Mailing Address - Phone:432-617-3855
Mailing Address - Fax:432-617-3840
Practice Address - Street 1:600 N MARIENFELD ST
Practice Address - Street 2:STE 308
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-4395
Practice Address - Country:US
Practice Address - Phone:432-617-3855
Practice Address - Fax:432-617-3840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE64962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0008NHOtherBCBS
TX0008NHOtherBCBS
TX0008NHOtherBCBS