Healthcare Provider Details

I. General information

NPI: 1841580370
Provider Name (Legal Business Name): MATTHEW LUNSER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN PABLO RD S MAYO CLINIC - FAMILY MEDICINE DEPARTMENT
JACKSONVILLE FL
32224-1865
US

IV. Provider business mailing address

4500 SAN PABLO RD S FAMILY MEDICINE - MAYO CLINIC
JACKSONVILLE FL
32224-1865
US

V. Phone/Fax

Practice location:
  • Phone: 904-953-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS 12766
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: