Provider Demographics
NPI:1790772044
Name:LUKE, MATHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:LUKE
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 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1699 S 14TH ST STE 2
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:904-427-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46998207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44998900Medicaid
FLP01593284OtherRR MEDICARE
FL042114OtherAVMED
GA000500497DMedicaid
FL1079407OtherCAREPLUS
GA000500497CMedicaid
FL1193388OtherWELLCARE
FL46791OtherBCBS OF FL
FLP0022951OtherFLORIDA HEALTHCARE PLUS
FLP10714532OtherSIMPLY HEALTHCARE
FL02684OtherBCBS
FL46791OtherBCBS OF FL
GA000500497DMedicaid
FL02684XMedicare PIN
FL02684YMedicare PIN
GA000500497CMedicaid