Basic Information
| Provider Information | |||||||||
| NPI: | 1679766414 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATHEW | ||||||||
| FirstName: | DANI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 PATRICIA AVE | ||||||||
| Address2: | |||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346988103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277334193 | ||||||||
| FaxNumber: | 8136352638 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 PATRICIA AVE | ||||||||
| Address2: | |||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346988103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277334193 | ||||||||
| FaxNumber: | 8136352638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2007 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | ME101657 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207Q00000X | ME101657 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001247700 | 05 | FL | MEDICAID | P00738915 | 01 | FL | RAILROAD MEDICARE PROVIDER NUMBER | OTHER |