Healthcare Provider Details

I. General information

NPI: 1801286166
Provider Name (Legal Business Name): ALEXIS MATHURA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS COLTER DO

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 SUN N LAKE BLVD STE 200
SEBRING FL
33872-1944
US

IV. Provider business mailing address

4240 SUN N LAKE BLVD STE 200
SEBRING FL
33872-1944
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-2229
  • Fax: 863-402-1209
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS17938
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: