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General NPI Number Information
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NPI Number | 1083702963
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Entity Type | Individual
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Provider Name | MATTHEW STEPHEN MCKILLOP M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 836 PRUDENTIAL DR STE 1700
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8344
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Country | US
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Telephone | 904-398-0125
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Fax | 904-398-1832
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Provider Business Mailing Address
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Address Line | PO BOX 746652
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City | ATLANTA
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State | GA
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Zip | 30374-6652
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Country | US
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Telephone | 904-202-2092
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Fax | 904-376-4075
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 61263
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME96218
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | ME96218
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME96218
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License Number State | FL
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