Provider Demographics
NPI:1821016817
Name:BURRY, MATTHEW V (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:V
Last Name:BURRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:200 N MANGOUSTINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1017
Mailing Address - Country:US
Mailing Address - Phone:407-833-7505
Mailing Address - Fax:407-833-7509
Practice Address - Street 1:305 N MANGOUSTINE AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1004
Practice Address - Country:US
Practice Address - Phone:407-833-7505
Practice Address - Fax:407-833-7509
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME81578207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI24971Medicare UPIN
FL52263YMedicare PIN