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Organization

ANITA MATHUR MD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LYNETTE TARNOWSKI (BILLING MANAGER)
(386) 774-7337
Entity
Organization

Contact information

Practice address
999 S VOLUSIA AVE STE B, ORANGE CITY, FL 32763-6564
(386) 774-7337
Mailing address
999 S VOLUSIA AVE STE B, ORANGE CITY, FL 32763-6564
(386) 774-7337

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME67495
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
37584
BCBS
05
379425300
FL
Enumeration date
02/12/2015
Last updated
02/12/2015
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