Provider Demographics
NPI:1669476594
Name:MERVIS, MATTHEW R (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:MERVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 S ORANGE AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1236
Mailing Address - Country:US
Mailing Address - Phone:407-205-7646
Mailing Address - Fax:407-264-7774
Practice Address - Street 1:1111 S ORANGE AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1236
Practice Address - Country:US
Practice Address - Phone:407-205-7646
Practice Address - Fax:407-264-7774
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2013-01-28
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Provider Licenses
StateLicense IDTaxonomies
FLME0049918207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD20966Medicare UPIN