Provider Demographics
NPI:1013996859
Name:PERRY, MATTHEW J (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:PERRY
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1 S SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6014
Practice Address - Country:US
Practice Address - Phone:941-309-7000
Practice Address - Fax:941-308-8508
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45819208800000X
FLME97146208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305536OtherAVMED
FL124774OtherUNIVERSAL
FLP01807671OtherCLEAR HEALTH
FLP105219OtherFREEDOM HEALTH
FL003884800Medicaid
FL7500847OtherAETNA
FLP01051886OtherRAILROAD MCR
MN974698600Medicaid
FL0262533OtherCIGNA
FLP302195OtherOPTIMUM
FL7500847OtherAETNA
FLP01807671OtherCLEAR HEALTH
MN340000785Medicare ID - Type Unspecified
FL305536OtherAVMED
FLP302195OtherOPTIMUM