Provider Demographics
NPI:1447230271
Name:MATHIS, ROBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:MATHIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:401 ALCORN DR
Mailing Address - Street 2:STE 2C
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9073
Mailing Address - Country:US
Mailing Address - Phone:662-284-9910
Mailing Address - Fax:662-284-9970
Practice Address - Street 1:611 ALCORN DR
Practice Address - Street 2:STE 210
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9323
Practice Address - Country:US
Practice Address - Phone:662-284-9910
Practice Address - Fax:662-284-9970
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2021-05-14
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Provider Licenses
StateLicense IDTaxonomies
MS9987208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00191096OtherRAILROAD MEDICARE
MS00013147Medicaid
P00191096OtherRAILROAD MEDICARE
MS00013147Medicaid