Healthcare Provider Details

I. General information

NPI: 1407384688
Provider Name (Legal Business Name): BRIAN MATTISON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 W BOYNTON BEACH BLVD STE 4
BOYNTON BEACH FL
33436-4516
US

IV. Provider business mailing address

3695 W BOYNTON BEACH BLVD STE 4
BOYNTON BEACH FL
33436-4516
US

V. Phone/Fax

Practice location:
  • Phone: 561-364-5522
  • Fax: 561-364-9828
Mailing address:
  • Phone: 561-364-5522
  • Fax: 561-364-9828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: