Provider Demographics
NPI:1194773259
Name:MATHEWS, WILLIAM CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHRISTOPHER
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:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4168 FRONT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2030
Practice Address - Country:US
Practice Address - Phone:619-543-3995
Practice Address - Fax:619-543-7841
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 032447207R00000X
CAG32447207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G324470Medicaid
CAC 04191Medicare UPIN
CAWG32447BMedicare ID - Type Unspecified