Provider Demographics
NPI:1215922125
Name:MATIAS, DELIA A I (MD)
Entity type:Individual
Prefix:MRS
First Name:DELIA
Middle Name:A
Last Name:MATIAS
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E BROADWAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8018
Mailing Address - Country:US
Mailing Address - Phone:573-875-2505
Mailing Address - Fax:573-449-6952
Practice Address - Street 1:1701 E BROADWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8018
Practice Address - Country:US
Practice Address - Phone:573-875-2505
Practice Address - Fax:573-449-6952
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-09
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
MOMD36299208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics