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General NPI Number Information
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NPI Number | 1407384688
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Entity Type | Individual
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Provider Name | BRIAN MATTISON DPM
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Gender | Male
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 3695 W BOYNTON BEACH BLVD STE 4
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4516
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Country | US
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Telephone | 561-364-5522
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Fax | 561-364-9828
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Provider Business Mailing Address
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Address Line | 7000 SW 62ND AVE STE 401
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4721
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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 |
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO4092
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License Number State | FL
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