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Individual
TIMOTHY J MATTISON
Active
Individual
TIMOTHY J MATTISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35070695
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000344553
ANTHEM
OH
05
—
2291407
—
OH
01
—
P00138896
RAILRAOD MEDICARE
OH
Enumeration date
07/13/2005
Last updated
01/07/2013
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