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Individual

DR. DARREL THOMAS MATHIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.,F.A.C.O.

Contact information

Practice address
279 SW MAIN BLVD, LAKE CITY, FL 32025-7050
(386) 752-4313
(386) 752-8356
Mailing address
279 SW MAIN BLVD, LAKE CITY, FL 32025-7050
(386) 752-4313
(386) 752-8356

Taxonomy

Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
CH5141
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
050782200
FL
01
350023404
RAILROAD MEDICARE
FL
Enumeration date
07/12/2005
Last updated
04/04/2008
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