Provider Demographics
NPI:1669451282
Name:SOUTHWICK, MATTHEW WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:SOUTHWICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1107 NAPLES DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8169
Mailing Address - Country:US
Mailing Address - Phone:850-497-1035
Mailing Address - Fax:850-505-6429
Practice Address - Street 1:6000 W HIGHWAY 98
Practice Address - Street 2:NAVAL HOSPITAL PENSACOLA PEDIATRICS DEPARTMENT
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-0001
Practice Address - Country:US
Practice Address - Phone:850-505-6421
Practice Address - Fax:850-505-6429
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-07-3961-S208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics