Individual
THOMAS PAUL MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1410 UNION ST, LAFAYETTE, IN 47904-2060
(765) 423-2977
(765) 423-1149
Mailing address
1410 UNION ST, LAFAYETTE, IN 47904-2060
(765) 423-2977
(765) 423-1149
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01026310A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000086144
ANTHEM INSURANCE
IN
01
—
35-1654025
AETNA
IN
01
—
351654025
BANKERS LIFE
IN
01
—
351654025 47904 002
TRICARE
IN
01
—
B29527
ADVANTAGE HEALTH SOLUTION
IN
Enumeration date
01/07/2006
Last updated
06/11/2012
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