Individual
DR. DANIEL KODIYATU MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17 DAVIS BLVD, SUITE 308, TAMPA, FL 33606-3475
(813) 259-0661
(813) 259-0697
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 821-8038
(813) 974-4325
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
ME143274
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115057800
—
FL
01
—
ZGFIJ
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/23/2016
Last updated
08/29/2022
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