Provider Demographics
NPI:1881602993
Name:DO, MATTHEW M (DPM, DABMSP)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:M
Last Name:DO
Suffix:
Gender:M
Credentials:DPM, DABMSP
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Other - First Name:
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Mailing Address - Street 1:275 VICTORIA ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1906
Mailing Address - Country:US
Mailing Address - Phone:949-645-3338
Mailing Address - Fax:949-226-8447
Practice Address - Street 1:275 VICTORIA ST STE 1D
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1906
Practice Address - Country:US
Practice Address - Phone:949-645-3338
Practice Address - Fax:949-226-8447
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3881213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38810Medicaid
CA000E38810Medicaid
CAU44122Medicare UPIN