Provider Demographics
NPI:1992007496
Name:MATTHEW TAUB MD PA
Entity Type:Organization
Organization Name:MATTHEW TAUB MD PA
Other - Org Name:MATTHEW TAUB MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-432-6595
Mailing Address - Street 1:12309 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1723
Mailing Address - Country:US
Mailing Address - Phone:954-432-6595
Mailing Address - Fax:954-432-6266
Practice Address - Street 1:12309 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1723
Practice Address - Country:US
Practice Address - Phone:954-432-6595
Practice Address - Fax:954-432-6266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82721261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH43511Medicare UPIN