Provider Demographics
NPI:1801197629
Name:HUBER MATOS MD PA
Entity Type:Organization
Organization Name:HUBER MATOS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOS-GARSAULT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-607-7235
Mailing Address - Street 1:3815 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-2005
Mailing Address - Country:US
Mailing Address - Phone:904-607-7235
Mailing Address - Fax:
Practice Address - Street 1:2570 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3604
Practice Address - Country:US
Practice Address - Phone:904-607-7235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89412207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty