Provider Demographics
NPI:1982806121
Name:SWICK, MATTHEW JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAY
Last Name:SWICK
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 1:4600 4TH STREET NORTH
Mailing Address - Street 2:ALL FLORIDA ORTHOPAEDIC ASSOCIATES
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3802
Mailing Address - Country:US
Mailing Address - Phone:727-527-5272
Mailing Address - Fax:727-522-7412
Practice Address - Street 1:4600 4TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3802
Practice Address - Country:US
Practice Address - Phone:727-527-5272
Practice Address - Fax:727-522-7412
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055453207X00000X
FLME102271207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000777800Medicaid
NCBS9070789OtherDEA
NCBS9070789OtherDEA