Individual
DAVID MATTSON
Active
Individual
DAVID MATTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01046972A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087174
ANTHEM
IN
05
—
200151820
—
IN
01
—
P00791451
RAILROAD MEDICARE PTAN
IN
Enumeration date
07/27/2006
Last updated
12/17/2020
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