Provider Demographics
NPI:1104814532
Name:MATHEWS, VASILIOS (MD)
Entity type:Individual
Prefix:
First Name:VASILIOS
Middle Name:
Last Name:MATHEWS
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 1:7401 S. MAIN ST
Mailing Address - Street 2:FONDREN ORTHOPEDIC GROUP L.L.P.
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4509
Mailing Address - Country:US
Mailing Address - Phone:713-799-2300
Mailing Address - Fax:713-794-3380
Practice Address - Street 1:7401 S. MAIN ST
Practice Address - Street 2:FONDREN ORTHOPEDIC GROUP L.L.P.
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4509
Practice Address - Country:US
Practice Address - Phone:713-799-2300
Practice Address - Fax:713-794-3380
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7475207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168733701Medicaid
TX8C7326Medicare ID - Type Unspecified
TXH37906Medicare UPIN