Provider Demographics
NPI:1275510125
Name:MATTHEWS, QUINTEN P (DPM)
Entity Type:Individual
Prefix:MR
First Name:QUINTEN
Middle Name:P
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 W SUNRISE BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6800
Mailing Address - Country:US
Mailing Address - Phone:954-724-3668
Mailing Address - Fax:
Practice Address - Street 1:5975 W SUNRISE BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6800
Practice Address - Country:US
Practice Address - Phone:954-724-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3009213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340327100Medicaid
FL340327100Medicaid
U80702Medicare UPIN