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Individual
JACK M MATHENY II
Active
Individual
JACK M MATHENY II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0048571
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046979300
—
FL
01
—
372143400
MEDICAID GROUP NUMBER FOR NON RURAL HEALTH SERVICES
FL
01
—
372143401
MEDICAID GROUP NUMBER FOR RURAL HEALTH CLINIC
FL
Enumeration date
02/02/2006
Last updated
04/02/2019
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