Individual
DR. JACOB MATHEW JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1650 COCHRANE CIR, EVANS ARMY COMMUNITY HOSPITAL, FORT CARSON, CO 80913-4613
(719) 526-6073
Mailing address
1650 COCHRANE CIR, EVANS ARMY COMMUNITY HOSPITAL, FORT CARSON, CO 80913-4613
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DOS-1566
HI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VAD000
UPIN
HI
Enumeration date
06/17/2012
Last updated
09/02/2015
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