Organization Name: | JOHN R GLYER D MILLS MATHESON & MARGARET ARNER MDS PTR |
NPI Number: | 1568525400 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DONALD MILLS MATHESON (MANAGING PARTNER) |
Mailing Address: | 1245 S Main St Willits |
State: | CA US |
Postal Code: | 954904305 |
Phone Number: | 7074596861 |
Fax Number: | 7074593057 |
NPI Enumeration Date: | 12/19/2006 |
NPI Last Update Date: | 12/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | 053968 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |