Healthcare Provider Details

I. General information

NPI: 1609339746
Provider Name (Legal Business Name): MATTHEW KHEIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2019
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1658 ST VINCENTS WAY STE 100
MIDDLEBURG FL
32068-8459
US

IV. Provider business mailing address

1658 ST VINCENTS WAY STE 100
MIDDLEBURG FL
32068-8459
US

V. Phone/Fax

Practice location:
  • Phone: 904-602-4481
  • Fax: 904-354-1340
Mailing address:
  • Phone: 904-602-4481
  • Fax: 904-354-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1609339746
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME175192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: