Healthcare Provider Details

I. General information

NPI: 1871896167
Provider Name (Legal Business Name): MARY JOYCE MATTHEWS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 SW 51ST CT
OCALA FL
34474-5770
US

IV. Provider business mailing address

6565 SW 51ST CT
OCALA FL
34474-5770
US

V. Phone/Fax

Practice location:
  • Phone: 352-304-8721
  • Fax: 352-304-8721
Mailing address:
  • Phone: 352-304-8721
  • Fax: 352-304-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number35-039793
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: