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General NPI Number Information
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NPI Number | 1306008602
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Entity Type | Individual
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Provider Name | J. BENJAMIN MATHIS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 1851 NW 10TH AVE
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City | MIAMI
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State | FL
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Zip | 33136-1054
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Country | US
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Telephone | 305-545-2488
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Fax |
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Provider Business Mailing Address
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Address Line | 1851 NW 10TH AVE
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City | MIAMI
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State | FL
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Zip | 33136-1054
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Country | US
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Telephone | 305-545-2488
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | MT192720
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207ZF0201X
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Taxonomy Name | Forensic Pathology Physician
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License Number | ME 112471
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD444608
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License Number State | PA
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