Provider Demographics
NPI:1760826499
Name:DENUNZIO, MATTHEW JORDAN (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JORDAN
Last Name:DENUNZIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 9TH ST N
Mailing Address - Street 2:STE 308
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5627
Mailing Address - Country:US
Mailing Address - Phone:239-643-7888
Mailing Address - Fax:239-643-4744
Practice Address - Street 1:599 9TH ST N
Practice Address - Street 2:STE 308
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5627
Practice Address - Country:US
Practice Address - Phone:239-643-7888
Practice Address - Fax:239-643-4744
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126025207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017750400Medicaid
FL5LYDTOtherBCBS
FLIQ306ZOtherMEDICARE
FLIQ306ZMedicare PIN