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Individual
ANGELO MARIO DE MATTOS
Active
Individual
ANGELO MARIO DE MATTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD192424
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009981555
—
AL
05
—
009981565
—
AL
01
—
04808231
MISSISSIPPI MEDCAID
MS
01
—
051524242
BLUE CROSS
AL
01
—
051524243
BLUE CROSS
AL
01
—
P00159465
RAILROAD MEDICARE
AL
Enumeration date
08/01/2006
Last updated
11/05/2019
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