Provider Demographics
NPI:1790402303
Name:MATZ, JOHN DAVID JR
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:MATZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6883 PALM GROVE CT
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6962
Mailing Address - Country:US
Mailing Address - Phone:561-568-0959
Mailing Address - Fax:
Practice Address - Street 1:6883 PALM GROVE CT
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33418-6962
Practice Address - Country:US
Practice Address - Phone:561-568-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program