Provider Demographics
NPI:1225399116
Name:PERALTA, MATHEW (MD)
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:
Last Name:PERALTA
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 1:4137 HUNTERS PARK LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7669
Mailing Address - Country:US
Mailing Address - Phone:407-261-2934
Mailing Address - Fax:407-636-7811
Practice Address - Street 1:4137 HUNTERS PARK LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7669
Practice Address - Country:US
Practice Address - Phone:407-261-2934
Practice Address - Fax:407-636-7811
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE29955208000000X
TXQ37652080P0204X
FLME140301208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine