Provider Demographics
NPI:1689887127
Name:MATFLERD, CAROLYNN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYNN
Middle Name:ANN
Last Name:MATFLERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLYNN
Other - Middle Name:
Other - Last Name:LEUPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1600 SW ARCHER RD BOX 100183
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0001
Mailing Address - Country:US
Mailing Address - Phone:352-392-0140
Mailing Address - Fax:352-392-0140
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-0140
Practice Address - Fax:352-392-0140
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA537452084P0800X
FLME1324192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105054800Medicaid
NJ724194Medicare ID - Type Unspecified