MEDICARE: ANTONY MATHEW M.D.

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
1	207RP1001X	Pulmonary Disease Physician	ME54955	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	290012967	OTHER	FL	RAILROAD PROVIDER NUMBER

General Provider Information

NPI Number	:	1770572836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONY MATHEW M.D.

Provider Business Mailing Address
First Line	:	1031 SE 9TH PL
Second Line	:	UNIT 2
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3003
Country	:	US
Telephone Number	:	239-574-2644
Fax Number	:	239-574-1451

Provider Business Practice Location Address
First Line	:	1031 SE 9TH PL
Second Line	:	UNIT 2
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3003
Country	:	US
Telephone Number	:	239-574-2644
Fax Number	:	239-574-1451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/26/2016

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Directions to “ ANTONY MATHEW M.D.” Practice Location

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