Healthcare Provider Details

I. General information

NPI: 1104913532
Provider Name (Legal Business Name): MATTHEW JON D'ALESSIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 GEORGE BUSH BLVD
DELRAY BEACH FL
33444-4034
US

IV. Provider business mailing address

229 GEORGE BUSH BLVD
DELRAY BEACH FL
33444-4034
US

V. Phone/Fax

Practice location:
  • Phone: 561-272-1234
  • Fax: 561-274-2060
Mailing address:
  • Phone: 561-272-1234
  • Fax: 561-274-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME 96070
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME 96070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: