Provider Demographics
NPI:1841222189
Name:MATHIAS, BILL JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:JEFFREY
Last Name:MATHIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:MATHIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3624 BUCKINGHAM DRIVE
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965
Mailing Address - Country:US
Mailing Address - Phone:936-569-6041
Mailing Address - Fax:936-560-6093
Practice Address - Street 1:4800 NE STALLINGS
Practice Address - Street 2:STE 1100
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965
Practice Address - Country:US
Practice Address - Phone:936-560-4100
Practice Address - Fax:936-560-6093
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8312208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116234904Medicaid
TX0017KWOtherBLUE CROSS BLUE SHIELD
TXTXB131597Medicare PIN
TX0017KWOtherBLUE CROSS BLUE SHIELD