Individual
MR. PAUL C MATTOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
500 S LIBERTY DR STE 482, BLOOMINGTON, IN 47403-1924
(812) 918-5907
(812) 353-6888
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10000648A
IN
363AM0700X
Medical Physician Assistant
Primary
10000648A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300018336
—
IN
Enumeration date
09/24/2006
Last updated
02/12/2024
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