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NPI Code Detail

MEDICARE: DR. DARREL THOMAS MATHIS D.C.,F.A.C.O.

MEDICARE:  DR. DARREL THOMAS MATHIS  D.C.,F.A.C.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NX0800XOrthopedic ChiropractorCH5141FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1350023404OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679571822
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DARREL THOMAS MATHIS D.C.,F.A.C.O.
Provider Business Mailing Address
First Line : 279 SW MAIN BLVD
Second Line :
City : LAKE CITY
State : FL
Zip : 32025-7050
Country : US
Telephone Number : 386-752-4313
Fax Number : 386-752-8356
Provider Business Practice Location Address
First Line : 279 SW MAIN BLVD
Second Line :
City : LAKE CITY
State : FL
Zip : 32025-7050
Country : US
Telephone Number : 386-752-4313
Fax Number : 386-752-8356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 04/04/2008

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