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Individual

DR. MATT SPENCER LALLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3200 SW 60TH CT STE 302, MIAMI, FL 33155-4071
(954) 371-0107
Mailing address
3200 SW 60TH CT STE 302, MIAMI, FL 33155-4071
(305) 662-8330

Taxonomy

Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
A116424
CA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
ME118674
FL
2084N0600X
Clinical Neurophysiology Physician
A116424
CA
2084N0600X
Clinical Neurophysiology Physician
ME118674
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
014784900
FL
Enumeration date
06/03/2011
Last updated
07/14/2022
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