MEDICARE: MR. MATTHEW KELLER MACLARTY PHYSICIAN ASSISTANT

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	208D00000X	General Practice Physician	9120407	FL
2	363A00000X	Physician Assistant	PA9120407	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699663971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW KELLER MACLARTY PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-468-0260
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 HEALTH CENTER BLVD STE 1050
Second Line	:
City	:	ESTERO
State	:	FL
Zip	:	34135-8130
Country	:	US
Telephone Number	:	239-468-0260
Fax Number	:	239-343-4254

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

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	11/10/2025

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