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NPI Code Detail

MEDICARE: JIMMY L MATHIS

MEDICARE: JIMMY L MATHIS
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
12085U0001XDiagnostic Ultrasound Physician00093077NV

General Provider Information

NPI Number : 1720709397
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIMMY L MATHIS
Provider Business Mailing Address
First Line : 2123 CIVIC CENTER DR
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89030-6327
Country : US
Telephone Number : 702-772-8063
Fax Number :
Provider Business Practice Location Address
First Line : 2123 CIVIC CENTER DR
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89030-6327
Country : US
Telephone Number : 702-772-8063
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2022
Last Update Date : 09/12/2022

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Directions to “ JIMMY L MATHIS ” Practice Location

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