Provider Demographics
NPI:1982430864
Name:MATTHEWS, JOHN ROGER II (PEER SPECIALIST)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROGER
Last Name:MATTHEWS
Suffix:II
Gender:M
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 PADDOCK CT STE 3
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1370
Mailing Address - Country:US
Mailing Address - Phone:419-946-5900
Mailing Address - Fax:
Practice Address - Street 1:241 PADDOCK CT STE 3
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1370
Practice Address - Country:US
Practice Address - Phone:419-946-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005070175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist