Individual
MARK STANLEY MATTHIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 CENTRACARE CIRCLE, SUITE 2400, ST. CLOUD, MN 56303-5000
(320) 229-5171
(320) 229-5171
Mailing address
1900 CENTRACARE CIRCLE, SUITE 2400, ST. CLOUD, MN 56303-5000
(320) 229-5099
(320) 229-5171
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33585
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
413202500
—
MN
01
—
P00631764
RR MEDICARE
MN
Enumeration date
11/17/2006
Last updated
04/07/2015
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