Provider Demographics
NPI:1265454094
Name:OBAL, MATTHEW J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:OBAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:JOHN
Other - Last Name:OBAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7550 W UNIVERSITY AVE
Mailing Address - Street 2:STE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-7608
Mailing Address - Country:US
Mailing Address - Phone:352-273-7766
Mailing Address - Fax:352-273-7849
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-7766
Practice Address - Fax:352-273-7849
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101203363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290875100Medicaid
FLE4438YMedicare PIN
P11693Medicare UPIN
FLE4438ZMedicare PIN
FLE4438Medicare ID - Type Unspecified