Provider Demographics
NPI:1306833587
Name:MATEY, MARK ANDREW (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:MATEY
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 1:13241 BARTRAM PARK BLVD
Mailing Address - Street 2:UNIT 1805
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5227
Mailing Address - Country:US
Mailing Address - Phone:904-224-2001
Mailing Address - Fax:904-224-2002
Practice Address - Street 1:13241 BARTRAM PARK BLVD
Practice Address - Street 2:SUITE 1809
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5227
Practice Address - Country:US
Practice Address - Phone:904-268-3686
Practice Address - Fax:904-268-7718
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2521213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
21698KMedicare PIN
21698JMedicare PIN
U63899Medicare UPIN
FL21698OMedicare PIN
21698MMedicare PIN
65490Medicare PIN
65490ZMedicare PIN
FL21698NMedicare PIN