Provider Demographics
NPI:1962658492
Name:MATHEWS, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:535 JOHN KNOX RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4117
Mailing Address - Country:US
Mailing Address - Phone:850-298-6003
Mailing Address - Fax:850-298-6054
Practice Address - Street 1:710 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYO
Practice Address - State:FL
Practice Address - Zip Code:32066-4127
Practice Address - Country:US
Practice Address - Phone:386-294-1226
Practice Address - Fax:386-294-4218
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN354208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics