Healthcare Provider Details

I. General information

NPI: 1689668832
Provider Name (Legal Business Name): BRUNO MICHAEL MATON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 DELANEY AVE
ORLANDO FL
32806-5411
US

IV. Provider business mailing address

929 S SPIGEL DR
VIRGINIA BEACH VA
23454-1817
US

V. Phone/Fax

Practice location:
  • Phone: 407-652-6000
  • Fax:
Mailing address:
  • Phone: 757-416-4886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberME169881
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number234744
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101243229
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: