Provider Demographics
NPI:1801286166
Name:MATHURA, ALEXIS (DO)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:MATHURA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:COLTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4240 SUN N LAKE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4240 SUN N LAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-1944
Practice Address - Country:US
Practice Address - Phone:863-402-2229
Practice Address - Fax:863-402-1209
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology