Provider Demographics
NPI:1003896507
Name:MATOS-FRAEBEL, JANE EVELYN (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:EVELYN
Last Name:MATOS-FRAEBEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:220 SW 84TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2754
Mailing Address - Country:US
Mailing Address - Phone:954-998-7760
Mailing Address - Fax:954-998-7761
Practice Address - Street 1:220 SW 84TH AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2754
Practice Address - Country:US
Practice Address - Phone:954-998-7760
Practice Address - Fax:954-998-7761
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME89082207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37799OtherBCBS OF FL
FL263355OtherAVMED
FL271407800Medicaid
FL263355OtherAVMED
FLI11397Medicare UPIN