Provider Demographics
NPI:1215965595
Name:MATHIAS, ROBERT S (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:MATHIAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 100296 PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0001
Mailing Address - Country:US
Mailing Address - Phone:352-627-9350
Mailing Address - Fax:352-273-9054
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG545202080P0210X
IL036-1634972080P0210X
FLME966772080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208735407Medicaid
WA8326829Medicaid
ID806503700Medicaid
FL276312500Medicaid
NV002086395Medicaid
NV002086395Medicaid
WA8326829Medicaid
FL276312500Medicaid
ID806503700Medicaid
FLU8717ZMedicare PIN