MEDICARE: MR. ROBERT JAY MUTERSPAUGH 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
1	363AM0700X	Medical Physician Assistant	003261	GA
2	363A00000X	Physician Assistant	003261	GA
3	363AS0400X	Surgical Physician Assistant	003261	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1124020425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT JAY MUTERSPAUGH PA-C

Provider Business Mailing Address
First Line	:	2400 BELLEVUE RD
Second Line	:	SUITE 21-A
City	:	DUBLIN
State	:	GA
Zip	:	31021-2885
Country	:	US
Telephone Number	:	478-275-7202
Fax Number	:	478-274-8418

Provider Business Practice Location Address
First Line	:	802 18TH ST E
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-3661
Country	:	US
Telephone Number	:	229-386-9333
Fax Number	:	229-386-1666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/12/2015

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