Individual
MATTHEW J MIFSUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 TAMPA GENERAL CIR FL CIRCLE2, TAMPA, FL 33606-3603
(813) 974-4683
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME132370
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021425700
—
FL
01
—
VSOT1
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/25/2010
Last updated
03/31/2021
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