Provider Demographics
NPI:1164815460
Name:MATHURIN, JEAN MARC (SA-C)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARC
Last Name:MATHURIN
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14153 SW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5978
Mailing Address - Country:US
Mailing Address - Phone:954-591-2880
Mailing Address - Fax:
Practice Address - Street 1:14153 SW 52ND ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5978
Practice Address - Country:US
Practice Address - Phone:954-591-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric