Provider Demographics
NPI:1689898843
Name:MATHEWS, GRANT (MD)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:MATHEWS
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 1:555 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3409
Mailing Address - Country:US
Mailing Address - Phone:870-425-1787
Mailing Address - Fax:870-425-2009
Practice Address - Street 1:555 WEST 6TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3207
Practice Address - Country:US
Practice Address - Phone:870-425-1787
Practice Address - Fax:870-425-2009
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5332207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine