Provider Demographics
NPI:1215910856
Name:MATHIS, JEREMY R (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:R
Last Name:MATHIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:70 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-1397
Mailing Address - Country:US
Mailing Address - Phone:614-839-3275
Mailing Address - Fax:614-823-8881
Practice Address - Street 1:1313 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3120
Practice Address - Country:US
Practice Address - Phone:614-839-3275
Practice Address - Fax:614-547-8881
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2016-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34.008175207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2552116Medicaid
OH11519723OtherCAQH
OH2552116Medicaid
OHMA4155371Medicare ID - Type Unspecified