Healthcare Provider Details

I. General information

NPI: 1184666513
Provider Name (Legal Business Name): MATTHEW S. TARGOFF D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 STRADA STELL CT STE 201
NAPLES FL
34109-4373
US

IV. Provider business mailing address

6360 TECHSTER BLVD STE 1
FORT MYERS FL
33966-4805
US

V. Phone/Fax

Practice location:
  • Phone: 239-597-0196
  • Fax: 239-597-5628
Mailing address:
  • Phone: 239-223-2751
  • Fax: 239-561-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS13697
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number120571-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: