Individual
MR. JAMES P MATTESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1141 N MONROE DR, XENIA, OH 45385-1619
(937) 372-8011
Mailing address
3131 NEWMARK DR STE 220, MIAMISBURG, OH 45342-5400
(937) 436-4658
(937) 436-4984
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.000486
OH
363AM0700X
Medical Physician Assistant
50000486
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0075462
—
OH
Enumeration date
10/25/2005
Last updated
05/06/2020
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