Provider Demographics
NPI:1770572836
Name:MATHEW, ANTONY (MD)
Entity type:Individual
Prefix:
First Name:ANTONY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 SE 9TH PL
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3003
Mailing Address - Country:US
Mailing Address - Phone:239-574-2644
Mailing Address - Fax:239-574-1451
Practice Address - Street 1:1031 SE 9TH PL
Practice Address - Street 2:UNIT 2
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3003
Practice Address - Country:US
Practice Address - Phone:239-574-2644
Practice Address - Fax:239-574-1451
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME54955207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290012967OtherRAILROAD PROVIDER NUMBER
FL08566ZMedicare PIN
FLC65377Medicare UPIN