Individual
BARRY A MATHISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2056 LEBANON RD, CRAWFORDSVILLE, IN 47933-2143
(765) 361-9930
(765) 361-9931
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1038539A
IN
208M00000X
Hospitalist Physician
01038539A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000207927
ANTHEM ID#
IN
05
—
100196520
—
IN
Enumeration date
11/13/2006
Last updated
08/02/2023
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