Provider Demographics
NPI:1407825953
Name:MATHIS, ANTHONY L (DPM LLC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:MATHIS
Suffix:
Gender:M
Credentials:DPM LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-2514
Mailing Address - Country:US
Mailing Address - Phone:864-879-4080
Mailing Address - Fax:864-879-4938
Practice Address - Street 1:127 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-2514
Practice Address - Country:US
Practice Address - Phone:864-879-4080
Practice Address - Fax:864-879-4938
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC502213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9948Medicaid
SCU63854Medicare UPIN
SCGP9948Medicaid