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General NPI Number Information
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NPI Number | 1770868416
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Entity Type | Organization
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Legal Business Name | T.R. MATIONG MD PA
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 10201 STATE ROAD 52
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City | HUDSON
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State | FL
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Zip | 34669-3071
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Country | US
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Telephone | 727-857-1818
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Fax | 727-857-1609
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Provider Business Mailing Address
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Address Line | 10201 STATE ROAD 52
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City | HUDSON
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State | FL
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Zip | 34669-3071
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Country | US
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Telephone | 727-857-1818
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Fax | 727-857-1609
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Authorized Official
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Title or Position | PRACTITIONER
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Name | DR. TEODULO R MATIONG JR.
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Credential | M.D.
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Telephone | 727-857-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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