Healthcare Provider Details

I. General information

NPI: 1487865671
Provider Name (Legal Business Name): ROBERT P MATHIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 STATE ST SUITE 1
SANTA BARBARA CA
93101-2539
US

IV. Provider business mailing address

PO BOX 4187
SANTA BARBARA CA
93140-4187
US

V. Phone/Fax

Practice location:
  • Phone: 805-569-7100
  • Fax: 805-569-7113
Mailing address:
  • Phone: 805-569-7100
  • Fax: 805-569-7113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA46123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: