Individual
MATHEW THERON SOUTHWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
2300 E 30TH ST BLDG D-101, FARMINGTON, NM 87401-8991
(505) 208-6280
(505) 564-3202
Mailing address
PO BOX 844088, DALLAS, TX 75284-4088
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1136642
NCCPA
NM
Enumeration date
09/20/2016
Last updated
05/19/2026
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