Provider Demographics
NPI:1326401266
Name:WIDNER, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:WIDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S PINE ISLAND RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3179
Mailing Address - Country:US
Mailing Address - Phone:954-473-6344
Mailing Address - Fax:
Practice Address - Street 1:600 S PINE ISLAND RD STE 300
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3179
Practice Address - Country:US
Practice Address - Phone:954-473-6344
Practice Address - Fax:954-476-9077
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME155665174400000X, 207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine