Individual
DOUGLAS MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3551 ROGER BROOKE DR APT 7, JBSA FT SAM HOUSTON, TX 78234
(210) 916-4218
Mailing address
3551 ROGER BROOKE DR, QUALITY SERVICES / 7TH FLOOR ATTN: MCHE-ZQQ, FT SAM HOUSTON, TX 78234-4504
(210) 916-4218
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101051857
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790766806
US ARMY
—
Enumeration date
11/07/2005
Last updated
09/16/2019
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