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General NPI Number Information
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NPI Number | 1255478129
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Entity Type | Organization
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Legal Business Name | MATTHEW M. DO. DPM A PROFFESIONAL CORPORATION
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 275 VICTORIA ST STE 1D
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City | COSTA MESA
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State | CA
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Zip | 92627-1906
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Country | US
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Telephone | 949-645-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 275 VICTORIA ST STE 1D
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City | COSTA MESA
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State | CA
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Zip | 92627-1906
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PODIATRIC MEDICINE
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Name | MATTHEW M DO
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Credential | DPM
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Telephone | 949-645-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | E3881
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E3881
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E3881
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License Number State | CA
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