Provider Demographics
NPI:1811084379
Name:MATHIEU, REESE A III (MD)
Entity type:Individual
Prefix:DR
First Name:REESE
Middle Name:A
Last Name:MATHIEU
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3601 NORTHSTAR RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2608
Mailing Address - Country:US
Mailing Address - Phone:972-235-0385
Mailing Address - Fax:972-235-3859
Practice Address - Street 1:3601 NORTHSTAR RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2608
Practice Address - Country:US
Practice Address - Phone:972-235-0385
Practice Address - Fax:972-235-3859
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF-1785208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE80296Medicare UPIN