Healthcare Provider Details

I. General information

NPI: 1730185356
Provider Name (Legal Business Name): MATTHEW EDWARD MEAGHER PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2776 CLEVELAND AVE
FORT MYERS FL
33901-5864
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1614
  • Fax: 239-343-3695
Mailing address:
  • Phone: 239-343-1614
  • Fax: 239-343-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9103746
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: