Provider Demographics
NPI:1912915265
Name:MATUTE, REYNALDO (MD)
Entity Type:Individual
Prefix:
First Name:REYNALDO
Middle Name:
Last Name:MATUTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11945 GRANDHAVEN DR STE G
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8091
Mailing Address - Country:US
Mailing Address - Phone:843-357-3334
Mailing Address - Fax:
Practice Address - Street 1:11945 GRANDHAVEN DR STE G
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-8091
Practice Address - Country:US
Practice Address - Phone:843-357-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27909207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8679Medicare PIN