Provider Demographics
NPI:1285168195
Name:HO, MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HO
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 1:1061 MEDICAL CENTER DR STE 305
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8227
Mailing Address - Country:US
Mailing Address - Phone:386-917-7410
Mailing Address - Fax:386-917-7407
Practice Address - Street 1:1061 MEDICAL CENTER DR STE 305
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8227
Practice Address - Country:US
Practice Address - Phone:386-917-7410
Practice Address - Fax:386-917-7407
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME137996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program