Provider Demographics
NPI:1649217076
Name:MATOS-GARSAULT, HUBER (MD)
Entity Type:Individual
Prefix:DR
First Name:HUBER
Middle Name:
Last Name:MATOS-GARSAULT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HUBER
Other - Middle Name:
Other - Last Name:MATOS-GARSAULT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HUBER MATOS MD
Mailing Address - Street 1:3815 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-2005
Mailing Address - Country:US
Mailing Address - Phone:904-607-7235
Mailing Address - Fax:
Practice Address - Street 1:2570 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3604
Practice Address - Country:US
Practice Address - Phone:904-398-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89412207LP2900X, 207L00000X
GA075466208VP0014X
FLME98412202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology