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General NPI Number Information
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NPI Number | 1629396718
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Entity Type | Organization
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Legal Business Name | MATTHEW ACTON DO PLLC
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 17523 DALE MABRY HWY N
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City | LUTZ
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State | FL
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Zip | 33548-4521
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Country | US
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Telephone | 813-960-3777
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Fax | 813-960-1777
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Provider Business Mailing Address
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Address Line | 17523 DALE MABRY HWY N
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City | LUTZ
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State | FL
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Zip | 33548-4521
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Country | US
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Telephone | 813-960-3777
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Fax | 813-960-1777
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW M ACTON
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Credential | D.O.
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Telephone | 813-960-3777
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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 | OS10505
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License Number State | FL
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