Provider Demographics
NPI:1649010364
Name:MATHES, CONNOR JAMES (MD)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:JAMES
Last Name:MATHES
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 1:14334 BLUEJACKET LN
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-8181
Mailing Address - Country:US
Mailing Address - Phone:913-484-8719
Mailing Address - Fax:
Practice Address - Street 1:14334 BLUEJACKET LN
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-8181
Practice Address - Country:US
Practice Address - Phone:913-484-8719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch