Provider Demographics
NPI:1255771333
Name:MATHIS, DEBORAH LYNN (DO)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:MATHIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VETERANS AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6444
Mailing Address - Country:US
Mailing Address - Phone:304-255-2121
Mailing Address - Fax:
Practice Address - Street 1:400 N JEFFERSON ST
Practice Address - Street 2:ROBERT C. BYRD CLINIC
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1177
Practice Address - Country:US
Practice Address - Phone:304-645-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVED0384A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine