Provider Demographics
NPI:1104014588
Name:MATHISON, ROBERT JAMES (RPA/RA/RT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:MATHISON
Suffix:
Gender:M
Credentials:RPA/RA/RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 15TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4334
Mailing Address - Country:US
Mailing Address - Phone:406-727-0484
Mailing Address - Fax:406-453-9504
Practice Address - Street 1:1101 26TH ST. S.
Practice Address - Street 2:BENEFIS HEALTHCARE- RADIOLOGY
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-455-5665
Practice Address - Fax:406-455-4978
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1417243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant