# T.R. MATIONG MD PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mationg Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770868416
- **Authorized official:** DR. TEODULO R MATIONG JR. M.D. (PRACTITIONER)
- **Authorized official phone:** (727) 857-1818

## Contact information

- **Practice address:** 10201 STATE ROAD 52, HUDSON, FL 34669-3071
- **Practice address phone:** (727) 857-1818
- **Practice address fax:** (727) 857-1609
- **Mailing address:** 10201 STATE ROAD 52, HUDSON, FL 34669-3071
- **Mailing address phone:** (727) 857-1818
- **Mailing address fax:** (727) 857-1609

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 10/13/2011
- **Last updated:** 07/08/2013