Provider Demographics
NPI:1720207814
Name:MATZ, JOHN D
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:MATZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 10TH AVE N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6607
Mailing Address - Country:US
Mailing Address - Phone:561-540-8100
Mailing Address - Fax:561-540-8489
Practice Address - Street 1:2290 10TH AVE N
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6607
Practice Address - Country:US
Practice Address - Phone:561-540-8100
Practice Address - Fax:561-540-8489
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME145952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D62687Medicare UPIN
50609Medicare ID - Type Unspecified