Provider Demographics
NPI:1912972530
Name:MATRICIA, DANIEL JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:MATRICIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:96279 BRADY POINT RD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-7076
Mailing Address - Country:US
Mailing Address - Phone:904-321-0088
Mailing Address - Fax:904-321-0016
Practice Address - Street 1:96279 BRADY POINT RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-7076
Practice Address - Country:US
Practice Address - Phone:904-321-0088
Practice Address - Fax:904-321-0016
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31289207Q00000X
FLOS6933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000411749DMedicaid
GA915652OtherBLUE CROSS
GA93BDQJGMedicare PIN
GA915652OtherBLUE CROSS