Individual
MR. GARY MATHERS LAKE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 MCFARLAND BLVD NE, STE 150, TUSCALOOSA, AL 35406-2283
(205) 758-9041
(205) 345-8328
Mailing address
1300 MCFARLAND BLVD NE, STE 150, TUSCALOOSA, AL 35406-2283
(205) 758-9041
(205) 345-8328
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
18921
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000025432
—
AL
01
—
051025432
BLUE CROSS BLUE SHIELD
AL
Enumeration date
06/29/2006
Last updated
07/18/2024
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