Provider Demographics
NPI:1164601126
Name:MATSON, ROBERT JOSEPH (PA-C , MPAS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:MATSON
Suffix:
Gender:M
Credentials:PA-C , MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-1126
Mailing Address - Country:US
Mailing Address - Phone:913-755-3044
Mailing Address - Fax:913-755-2184
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-1126
Practice Address - Country:US
Practice Address - Phone:913-755-3044
Practice Address - Fax:913-755-2184
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03358363AM0700X
KS15-01972363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS63756Medicare UPIN