Provider Demographics
NPI:1184731739
Name:MATHEWS, DANIEL DE FAZIO (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DE FAZIO
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PLAZA REAL S APT 1212
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-4869
Mailing Address - Country:US
Mailing Address - Phone:203-442-3121
Mailing Address - Fax:800-708-1338
Practice Address - Street 1:3196 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6700
Practice Address - Country:US
Practice Address - Phone:561-849-3000
Practice Address - Fax:800-708-1338
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4494213ES0131X
NY004379213ES0131X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006469Medicare UPIN
G400021890Medicare PIN