Provider Demographics
NPI:1922310952
Name:MATHIAS, MARK ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:MATHIAS
Suffix:
Gender:M
Credentials:PA-C
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 SHIRCLIFF WAY
Mailing Address - Street 2:SUITE 605, DEPAUL BLDG
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4753
Mailing Address - Country:US
Mailing Address - Phone:904-328-5979
Mailing Address - Fax:904-619-9925
Practice Address - Street 1:2627 RIVERSIDE AVE STE 300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4712
Practice Address - Country:US
Practice Address - Phone:904-634-0640
Practice Address - Fax:904-634-0203
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105501363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical