Individual
DR. JASON EARL MATHERNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3530 FANNIN ST, BEAUMONT, TX 77701-3805
(409) 842-8222
(409) 842-8244
Mailing address
3530 FANNIN ST, BEAUMONT, TX 77701-3805
(409) 842-8222
(409) 842-8244
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
L3744
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121679801
—
TX
05
—
121679802
—
TX
05
—
121679805
—
TX
05
—
152655003
—
TX
05
—
152655004
—
TX
01
—
N0123265
DPS
TX
Enumeration date
09/20/2006
Last updated
12/16/2011
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