Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 35077172M | OH |
N | 208600000X | Surgeon | 35077172M | OH |
N | 208200000X | Surgeon | ME128227 | FL |
N | 208600000X | Surgeon | ME128227 | FL |
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME128227 | FL |
NPI | 1144315821 |
---|---|
Provider Name | Dr. Mark Eugene Mathieson |
First Address | Sarasota, FL 34238-3142 |
Second Address | Sarasota, FL 34238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 07/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2331631 | (05) | OH |
H39832 | (02) | OH |
ME1281227 | MEDICAL LICENSE (01) | FL |