Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CH1537 | FL |
NPI | 1174928204 |
---|---|
Provider Name | Alexander Matos |
First Address | Plantation, FL 33322-4427 |
Second Address | Plantation, FL 33322-4427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2014 |
Last Update Date | 31/10/2014 |