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NPI Code Detail

MEDICARE: RAYMOND MATHIESON PA-C

MEDICARE: RAYMOND MATHIESON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA893NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023010576
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYMOND MATHIESON PA-C
Provider Business Mailing Address
First Line : PO BOX 15645
Second Line :
City : LAS VEGAS
State : NV
Zip : 89114-5645
Country : US
Telephone Number : 702-877-8600
Fax Number : 702-258-6152
Provider Business Practice Location Address
First Line : 888 S RANCHO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-3810
Country : US
Telephone Number : 702-877-8600
Fax Number : 702-258-6152
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 01/23/2017

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Directions to “ RAYMOND MATHIESON PA-C” Practice Location

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