Healthcare Provider Details

I. General information

NPI: 1134148067
Provider Name (Legal Business Name): RICARDO LUIS MATOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 NE 25TH ST
LIGHTHOUSE POINT FL
33064-7744
US

IV. Provider business mailing address

1821 NE 25TH ST
LIGHTHOUSE POINT FL
33064-7744
US

V. Phone/Fax

Practice location:
  • Phone: 954-942-0321
  • Fax: 954-946-7018
Mailing address:
  • Phone: 954-942-0321
  • Fax: 954-946-7018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD417760
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME90399
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME90399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: