Provider Demographics
NPI:1780839738
Name:DEACHIN, MATTHEW TERRY (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TERRY
Last Name:DEACHIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 TURNER ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5921
Mailing Address - Country:US
Mailing Address - Phone:727-446-0176
Mailing Address - Fax:727-442-0696
Practice Address - Street 1:1266 TURNER ST
Practice Address - Street 2:MICHAEL MARKOU DO PLC
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-446-0176
Practice Address - Fax:727-442-0696
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9104487363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant