MEDICARE: RICARDO LUIS MATOS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME90399	FL
2	207X00000X	Orthopaedic Surgery Physician	MD417760	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0502872	OTHER	FL	GHI
2	50209	OTHER	FL	BC/BS

General Provider Information

NPI Number	:	1134148067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO LUIS MATOS MD

Provider Business Mailing Address
First Line	:	1821 NE 25TH ST
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7744
Country	:	US
Telephone Number	:	954-942-0321
Fax Number	:	954-946-7018

Provider Business Practice Location Address
First Line	:	1821 NE 25TH ST
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7744
Country	:	US
Telephone Number	:	954-942-0321
Fax Number	:	954-946-7018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	01/24/2023

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Directions to “ RICARDO LUIS MATOS MD” Practice Location

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