Provider Demographics
NPI:1629396718
Name:MATTHEW ACTON DO PLLC
Entity Type:Organization
Organization Name:MATTHEW ACTON DO PLLC
Other - Org Name:ACTION MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:ACTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-960-3777
Mailing Address - Street 1:17523 DALE MABRY HWY N
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4521
Mailing Address - Country:US
Mailing Address - Phone:813-960-3777
Mailing Address - Fax:813-960-1777
Practice Address - Street 1:17523 DALE MABRY HWY N
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4521
Practice Address - Country:US
Practice Address - Phone:813-960-3777
Practice Address - Fax:813-960-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDI020AMedicare PIN