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Individual
SELBY KODUVATHARA MATHEWS
Active
Individual
SELBY KODUVATHARA MATHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
753022
TX
367500000X
Certified Registered Nurse Anesthetist
753022
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP126267
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
343636201
—
TX
01
—
8129UJ
BCBS
TX
01
—
P01466073
RR MEDICARE
TX
Enumeration date
10/13/2014
Last updated
11/30/2021
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