Provider Demographics
NPI:1407826282
Name:MATHIS, CHRISTOPHER B (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:MATHIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:775-851-1505
Mailing Address - Fax:
Practice Address - Street 1:5575 KIETZKE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2290
Practice Address - Country:US
Practice Address - Phone:775-851-1505
Practice Address - Fax:775-851-1583
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV7237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1407826282Medicaid
NV1407826282Medicaid
34264Medicare ID - Type Unspecified