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General NPI Number Information
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NPI Number | 1972235166
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Entity Type | Individual
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Provider Name | ISAAC J MATTIS
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Gender | Male
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 202 E MAIN ST
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City | STANBERRY
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State | MO
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Zip | 64489-1358
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Country | US
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Telephone | 660-783-2192
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Fax | 660-783-2616
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Provider Business Mailing Address
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Address Line | 202 E MAIN ST
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City | STANBERRY
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State | MO
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Zip | 64489-1358
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Country | US
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Telephone | 660-783-2192
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Fax | 660-783-2616
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2864
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2025032839
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License Number State | MO
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