Individual
JACQUIN P MATTHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
851 W TERRELL AVE, FORT WORTH, TX 76104-3161
(817) 870-1551
(817) 870-1818
Mailing address
PO BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 870-1818
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
J4909
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034648803
—
TX
01
—
P00007979
RAILROAD MEDICARE
—
Enumeration date
07/25/2006
Last updated
10/14/2011
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