Southwick, Mathew Theron

Southwick, Mathew Theron is an individual health care provider with primary practice located at 2300 E 30Th St Bldg D-101 , Farmington NM 87401-8991. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Southwick, Mathew Theron can be contacted via phone (505) 327-1400.

Contact Information

Primary practice address
2300 E 30Th St Bldg D-101 Farmington NM 87401-8991
Phone: (505) 327-1400
Fax: (505) 564-3202
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X

Profile Details

NPI number 1346798204
LBN Legal business name Southwick, Mathew Theron
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2016
Last updated Sep 20th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346798204 NPPES
New Mexico Other 1136642 NCCPA

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