Individual
SUSAN ELIZABETH MATTOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LM
Contact information
Practice address
434 GROVE AVE, WINTER PARK, FL 32789-3651
(407) 644-5567
(407) 644-4975
Mailing address
434 GROVE AVE, WINTER PARK, FL 32789-3651
(407) 644-5567
(407) 644-4975
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
MW183
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340552400
—
FL
01
—
Y00U1
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
Enumeration date
09/27/2006
Last updated
01/12/2012
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