Individual
DR. MARK J. MATOUKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
703 N FLAMINGO RD, PEMBROKE PINES, FL 33028-1006
(954) 433-7120
Mailing address
14050 NW 14TH ST, SUITE 190, SUNRISE, FL 33323-2865
(800) 424-3672
(954) 377-3042
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME75292
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
254120300
—
FL
01
—
42959
BLUE SHIELD OF FL
FL
Enumeration date
06/12/2006
Last updated
03/18/2021
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