Provider Demographics
NPI:1184666513
Name:TARGOFF, MATTHEW S (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:TARGOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 TECHSTER BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-4805
Mailing Address - Country:US
Mailing Address - Phone:239-223-2751
Mailing Address - Fax:239-561-2933
Practice Address - Street 1:9015 STRADA STELL CT
Practice Address - Street 2:STE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4373
Practice Address - Country:US
Practice Address - Phone:239-597-0196
Practice Address - Fax:239-597-5628
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS136972084P0800X
NY120571-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6234955Medicaid
IAI2040Medicare PIN
IA6234955Medicaid