Individual
TIMOTHY ALAN MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
202 S WALNUT ST, PINCKNEYVILLE, IL 62274
(618) 357-2791
Mailing address
202 S WALNUT ST, PO BOX 116, PINCKNEYVILLE, IL 62274
(618) 357-2791
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0366088252
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-088252
STATE MEDICAL LICENSE
IL
Enumeration date
03/20/2007
Last updated
03/23/2011
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