Provider Demographics
NPI:1205977451
Name:MATHEWS, JAMES C (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:847-924-8265
Mailing Address - Fax:
Practice Address - Street 1:3400 WAKE FOREST ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4430
Practice Address - Country:US
Practice Address - Phone:919-954-3271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-117010207P00000X
MI5101018516207P00000X
NC2011-00660207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-117010OtherSTATE MEDICAL LICENSE
MI5101018516OtherMICHIGAN MEDICAL LICENSE
IL036-117010OtherSTATE MEDICAL LICENSE