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General NPI Number Information
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NPI Number | 1588855431
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Entity Type | Organization
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Legal Business Name | PRADEEP MATHUR, M.D., P.A.
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 999 S VOLUSIA AVE
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City | ORANGE CITY
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State | FL
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Zip | 32763-6564
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Country | US
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Telephone | 386-775-7001
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Fax | 386-774-2561
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Provider Business Mailing Address
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Address Line | 999 S VOLUSIA AVE
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City | ORANGE CITY
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State | FL
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Zip | 32763-6564
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Country | US
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Telephone | 386-775-7001
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Fax | 386-774-2561
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Authorized Official
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Title or Position | OWNER
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Name | DR. PRADEEP MATHUR
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Credential | M.D.
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Telephone | 386-775-7001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME38056
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License Number State | FL
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