Provider Demographics
NPI:1124052022
Name:ADAMS, MATHIS T. (MD PA)
Entity type:Individual
Prefix:
First Name:MATHIS T.
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SW 26TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-8249
Mailing Address - Country:US
Mailing Address - Phone:940-325-7064
Mailing Address - Fax:940-325-7066
Practice Address - Street 1:214 SW 26TH AVE
Practice Address - Street 2:STE A
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067
Practice Address - Country:US
Practice Address - Phone:940-325-7064
Practice Address - Fax:940-325-7066
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4842208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C8812OtherMEDICARE INDIVIDUAL NUMBE
TX0034LNOtherBLUE CROSS BLUE SHIELD
I21730Medicare UPIN