Provider Demographics
NPI:1932427069
Name:MATHIASEN, ROSS EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:EDWARD
Last Name:MATHIASEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:981150 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-1150
Mailing Address - Country:US
Mailing Address - Phone:402-559-6637
Mailing Address - Fax:402-559-9659
Practice Address - Street 1:981150 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-1150
Practice Address - Country:US
Practice Address - Phone:402-559-6637
Practice Address - Fax:402-559-9659
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2015-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IAR-8823207P00000X
IA40647207P00000X
NE28791207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine