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NPI Code Detail

MEDICARE: MR. MATTHEW J GILES PA-C

MEDICARE: MR. MATTHEW J GILES PA-C
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
1363AM0700XMedical Physician AssistantPA9103350FL
2363A00000XPhysician AssistantPA9103350FL

Other Identifiers

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

General Provider Information

NPI Number : 1942371240
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW J GILES PA-C
Provider Business Mailing Address
First Line : 11945 SAN JOSE BLVD STE 300
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32223-1627
Country : US
Telephone Number : 904-396-1725
Fax Number : 904-396-4893
Provider Business Practice Location Address
First Line : 11705 SAN JOSE BLVD STE 103
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32223-1653
Country : US
Telephone Number : 904-880-0911
Fax Number : 904-880-9388
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2006
Last Update Date : 06/26/2019

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