Mathis, Randall T

Mathis, Randall T is an individual health care provider with primary practice located at 100 Whetstone Pl Ste 310, St Augustine FL 32086-5774. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Mathis, Randall T can be contacted via phone (904) 217-7450.

Contact Information

Primary practice address
100 Whetstone Pl Ste 310 St Augustine FL 32086-5774
Phone: (904) 217-7450
Fax: (904) 217-7483
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9101202 Florida
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA9101202 Florida

Profile Details

NPI number 1922055391
LBN Legal business name Mathis, Randall T
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date May 30th, 2006
Last updated Apr 16th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922055391 NPPES
Florida MEDICAID 004707900
Florida Other Y04HB

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