Provider Demographics
NPI:1356325153
Name:MATAR, LINDA JOY (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JOY
Last Name:MATAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9809 BAY ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4217
Mailing Address - Country:US
Mailing Address - Phone:813-781-1705
Mailing Address - Fax:
Practice Address - Street 1:9809 BAY ISLAND DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4217
Practice Address - Country:US
Practice Address - Phone:813-781-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65181207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00669490OtherRR MEDICARE
FL375338700Medicaid
FL375338700Medicaid
FLP00669490OtherRR MEDICARE
FL25885WMedicare PIN
F89964Medicare UPIN