Healthcare Provider Details

I. General information

NPI: 1104137793
Provider Name (Legal Business Name): MATTHEW JORDAN STEADMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

5571 SW 64TH ST
GAINESVILLE FL
32608-9608
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0239
  • Fax: 352-265-1107
Mailing address:
  • Phone: 352-337-4900
  • Fax: 352-337-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME116547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: