Provider Demographics
NPI:1275636698
Name:MATHIS, DAVID LEWIS (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEWIS
Last Name:MATHIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:9770 S MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523
Mailing Address - Country:US
Mailing Address - Phone:775-322-4589
Mailing Address - Fax:775-322-3787
Practice Address - Street 1:9770 S MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523
Practice Address - Country:US
Practice Address - Phone:775-322-4589
Practice Address - Fax:775-322-3787
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV6812207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016490Medicaid
NV002016490Medicaid
F01023Medicare UPIN