Provider Demographics
NPI:1811256050
Name:MATHEW, JEAN (DO)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
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:PO BOX 1191
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74101-1191
Mailing Address - Country:US
Mailing Address - Phone:918-710-4210
Mailing Address - Fax:918-949-6584
Practice Address - Street 1:1705 E 19TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5405
Practice Address - Country:US
Practice Address - Phone:918-872-6880
Practice Address - Fax:918-949-6570
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program