Individual
DR. RONALD EDWIN MATTISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6005 PARK AVE, SUITE 700, MEMPHIS, TN 38119-5202
(901) 527-3391
Mailing address
6005 PARK AVE, SUITE 700, MEMPHIS, TN 38119-5202
(901) 527-3391
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036118870
IL
208600000X
Surgery Physician
048275
GA
208600000X
Surgery Physician
Primary
45847
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036118070
—
IL
01
—
135084
HAMP
IL
01
—
320875
GHP
IL
01
—
3932056
BCBS
IL
01
—
7210895
AETNA
IL
01
—
869299
HEALTHLINK
IL
Enumeration date
01/05/2006
Last updated
09/15/2010
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