Provider Demographics
NPI:1104913532
Name:D'ALESSIO, MATTHEW JON (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JON
Last Name:D'ALESSIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 GEORGE BUSH BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-4034
Mailing Address - Country:US
Mailing Address - Phone:561-272-1234
Mailing Address - Fax:561-274-2060
Practice Address - Street 1:229 GEORGE BUSH BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-4034
Practice Address - Country:US
Practice Address - Phone:561-272-1234
Practice Address - Fax:561-274-2060
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 960702086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119388Medicaid
ILP00472576OtherRAILROAD MEDICARE
FLDK728ZMedicare PIN
IL036119388Medicaid