Provider Demographics
NPI:1841371697
Name:STANDRIDGE, MATTHEW THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:STANDRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3900 ESPLANADE WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-0802
Mailing Address - Country:US
Mailing Address - Phone:850-431-3867
Mailing Address - Fax:850-431-3879
Practice Address - Street 1:15 COUNCIL MOORE RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-3117
Practice Address - Country:US
Practice Address - Phone:850-926-7105
Practice Address - Fax:850-926-2034
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO44268207Q00000X
NC200700809207Q00000X
FLME109430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003679200Medicaid
FL14EN3OtherBCBS
FL003679200Medicaid