Provider Demographics
NPI:1922113752
Name:MATHISON, JEFFREY ALAN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:MATHISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7200 NORMANDY BLVD STE 20
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6271
Practice Address - Country:US
Practice Address - Phone:904-378-8520
Practice Address - Fax:904-378-8570
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038538A207Q00000X
FLME134714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100172880Medicaid
IN100172880Medicaid
ININ1213006Medicare PIN
IN250960MMedicare PIN
INE21286Medicare UPIN
IN198050Medicare PIN
INM400070859Medicare PIN
IN220620E7Medicare PIN
IN940550O1Medicare PIN
INP00724951OtherRAILROAD INDIVIDUAL
INE21286Medicare UPIN