Healthcare Provider Details

I. General information

NPI: 1225651771
Provider Name (Legal Business Name): DAVID MATSIBEKKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 SW 16TH AVE BLDG A
GAINESVILLE FL
32608-1158
US

IV. Provider business mailing address

1699 SW 16TH AVE BLDG A
GAINESVILLE FL
32608-1158
US

V. Phone/Fax

Practice location:
  • Phone: 352-627-9350
  • Fax:
Mailing address:
  • Phone: 352-627-9350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME161223
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: