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NPI Code Detail

MEDICARE: DR. MATTHEW DEMORE III D.P.M.

MEDICARE: DR. MATTHEW DEMORE III D.P.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery Podiatrist36-002649DOH
2213ES0103XFoot & Ankle Surgery PodiatristPOD001325GA

General Provider Information

NPI Number : 1659378750
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW DEMORE III D.P.M.
Provider Business Mailing Address
First Line : PO BOX 407
Second Line :
City : VIDALIA
State : GA
Zip : 30475-0407
Country : US
Telephone Number : 912-538-0040
Fax Number : 912-538-7070
Provider Business Practice Location Address
First Line : 400 CEDAR ST
Second Line :
City : METTER
State : GA
Zip : 30439-3338
Country : US
Telephone Number : 912-685-5741
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/22/2024

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