Provider Demographics
NPI:1356413538
Name:MATEZ, MITCHELL F (DO)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:F
Last Name:MATEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8345 VIA LEONESSA
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-483-8672
Mailing Address - Fax:
Practice Address - Street 1:7300 N FEDERAL HWY
Practice Address - Street 2:SUITE #100
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487
Practice Address - Country:US
Practice Address - Phone:561-995-8484
Practice Address - Fax:561-995-7773
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8439208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E97784Medicare UPIN