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General NPI Number Information
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NPI Number | 1316651029
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Entity Type | Individual
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Provider Name | MATTHEW DOUGLAS RADDING PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 1005 N 35TH AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5402
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Country | US
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Telephone | 954-265-6301
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Fax | 954-985-1434
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Provider Business Mailing Address
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Address Line | 1117 E HALLANDALE BEACH BLVD
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4488
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Country | US
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Telephone | 954-454-5131
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Fax | 954-241-6908
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9119276
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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