Healthcare Provider Details

I. General information

NPI: 1740292598
Provider Name (Legal Business Name): EDDIE MATHIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 S EASTERN AVE STE 1300
LAS VEGAS NV
89119-7826
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 702-243-8500
  • Fax: 702-363-8753
Mailing address:
  • Phone: 702-243-8500
  • Fax: 702-363-8753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6138
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: