Provider Demographics
NPI:1053381939
Name:MATHESON, ANGUS DUNCAN (MD)
Entity type:Individual
Prefix:
First Name:ANGUS
Middle Name:DUNCAN
Last Name:MATHESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-4305
Mailing Address - Country:US
Mailing Address - Phone:707-459-6861
Mailing Address - Fax:707-459-3057
Practice Address - Street 1:1245 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-4305
Practice Address - Country:US
Practice Address - Phone:707-459-6861
Practice Address - Fax:707-459-3057
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA070233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A702330Medicare PIN
H34208Medicare UPIN
ZZZ78182ZMedicare Oscar/Certification