Organization
OTSENRE E MATOS M D P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OTSENRE E MATOS MD (OWNER/MEDICAL DIRECTOR)
(727) 849-2005
Entity
Organization
Contact information
Practice address
4821 US HIGHWAY 19 STE 1, NEW PRT RCHY, FL 34652-4259
(727) 849-2005
(727) 849-2087
Mailing address
PO BOX 1014, ELFERS, FL 34680-1014
(727) 849-2005
(727) 849-2087
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
162704600
FEDERAL WORKERS COMP
FL
01
—
CH4227
MEDICARE RAILROAD
FL
Enumeration date
10/20/2006
Last updated
07/25/2013
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