Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | G54520 | CA |
Y | 2080P0210X | Pediatric Nephrologist | ME96677 | FL |
NPI | 1215965595 |
---|---|
Provider Name | Robert S. Mathias |
First Address | Rockland, DE 19732-0191 |
Second Address | Orlando, FL 32806-2946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 05/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002086395 | (05) | NV |
208735407 | (05) | MO |
276312500 | (05) | FL |
806503700 | (05) | ID |
8326829 | (05) | WA |
D98907 | (02) | CA |
D98907 | (02) | FL |