Provider Demographics
NPI:1982604989
Name:MATHIAS, PATRICK F (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:F
Last Name:MATHIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 OAK COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4213
Mailing Address - Country:US
Mailing Address - Phone:407-846-0626
Mailing Address - Fax:407-846-2371
Practice Address - Street 1:601 OAK COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4213
Practice Address - Country:US
Practice Address - Phone:407-846-0626
Practice Address - Fax:407-846-2371
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048028207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042818300Medicaid
FL49071ZMedicare ID - Type Unspecified
FLD55573Medicare UPIN