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Individual

DR. JOHN GLENN MATHIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
17501 GENERATIONS DR, SOUTH BEND, IN 46635-1589
(574) 234-0049
(574) 251-2861
Mailing address
17501 GENERATIONS DR, SOUTH BEND, IN 46635-1589
(574) 234-0049
(574) 251-2861

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01026543A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000084425
ANTHEM
IN
05
100223380A
IN
01
110082368
RAILROAD MEDICARE
IN
01
2010421004
CIGNA
IN
01
4359074
AETNA
IN
Enumeration date
05/24/2005
Last updated
10/04/2010
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