Healthcare Provider Details

I. General information

NPI: 1609208545
Provider Name (Legal Business Name): MORGAN MATHIAS DEMBINSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN ANNE MATHIAS PA-C

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 SE RIVERSIDE DR STE 303
STUART FL
34994-2579
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-9111
  • Fax: 772-283-2955
Mailing address:
  • Phone: 772-223-2832
  • Fax: 772-223-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 9107342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: