Organization
CARLOS MATA P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARLOS MATA M.D. (MEDICAL DIRECTOR)
(850) 920-3223
Entity
Organization
Contact information
Practice address
424 W HWY 90, CRESTVIEW, FL 32536-2638
(850) 689-2260
Mailing address
205 TOOKE ST, FORT WALTON BEACH, FL 32547-2681
(850) 920-3223
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
ME111574
FL
Other
Enumeration date
12/27/2012
Last updated
12/27/2012
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