Organization
MATERIA MEDICA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW DONNELLY PA-C (OWNER)
(239) 223-0039
Entity
Organization
Contact information
Practice address
2804 DEL PRADO BLVD S STE 109, CAPE CORAL, FL 33904-7283
(239) 223-0039
Mailing address
PO BOX 152974, CAPE CORAL, FL 33915-2974
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
PA 9104124
FL
Other
Enumeration date
12/10/2015
Last updated
12/10/2015
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