Healthcare Provider Details

I. General information

NPI: 1356413538
Provider Name (Legal Business Name): MITCHELL F MATEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FEDERAL HWY SUITE #100
BOCA RATON FL
33487
US

IV. Provider business mailing address

8345 VIA LEONESSA
BOCA RATON FL
33433
US

V. Phone/Fax

Practice location:
  • Phone: 561-995-8484
  • Fax: 561-995-7773
Mailing address:
  • Phone: 561-483-8672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS8439
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: