MEDICARE: TEODULO REYES MATIONG 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	207R00000X	Internal Medicine Physician	ME 0028139	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	225165	OTHER	FL	WELLCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	225165	OTHER	FL	WELLCARE/STAYWELL

General Provider Information

NPI Number	:	1386739506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEODULO REYES MATIONG MD

Provider Business Mailing Address
First Line	:	14690 SPRING HILL DR STE 305
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-8102
Country	:	US
Telephone Number	:	352-277-5348
Fax Number	:	352-606-2857

Provider Business Practice Location Address
First Line	:	10201 SR 52
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34669
Country	:	US
Telephone Number	:	727-857-1818
Fax Number	:	727-857-1609

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	06/04/2018

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