Individual
JENNIFER MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
(918) 456-0641
Mailing address
1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
(918) 456-0641
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
54065
AZ
207R00000X
Internal Medicine Physician
25428
OK
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
25428
OK
Other
Enumeration date
02/19/2007
Last updated
06/23/2021
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