Provider Demographics
NPI:1659552305
Name:MATER, SIMONE GRACA (MD)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:GRACA
Last Name:MATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8431 POINTE LOOP DR
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2232
Mailing Address - Country:US
Mailing Address - Phone:941-207-5320
Mailing Address - Fax:941-207-5321
Practice Address - Street 1:8431 POINTE LOOP DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-2232
Practice Address - Country:US
Practice Address - Phone:941-207-5320
Practice Address - Fax:941-207-5321
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME112920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01128000OtherRAILROAD MEDICARE
FL006232100Medicaid
FL006232100Medicaid