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Individual

JACK E MATTESON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1026 NORTHEAST DR, STE E, JEFFERSON CITY, MO 65109-2517
(573) 635-3850
(573) 635-1558
Mailing address
1026 NORTHEAST DR, STE E, JEFFERSON CITY, MO 65109-2517
(573) 635-3850
(573) 635-1558

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2007037859
MO
2084P0804X
Child & Adolescent Psychiatry Physician
2007037859
MO

Other

Enumeration date
03/05/2008
Last updated
12/15/2010
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