Provider Demographics
NPI: | 1285923292 |
---|---|
Name: | ASSING, MATTHEW ALLAN (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | MATTHEW |
Middle Name: | ALLAN |
Last Name: | ASSING |
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: | 2125 CRYSTAL GROVE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | LAKELAND |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33801-6875 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 863-688-2334 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2125 CRYSTAL GROVE DR |
Practice Address - Street 2: | |
Practice Address - City: | LAKELAND |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33801-6875 |
Practice Address - Country: | US |
Practice Address - Phone: | 863-688-2334 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-03-30 |
Last Update Date: | 2022-10-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A146631 | 2085R0001X |
FL | ME119819 | 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | JK326Z | Other | MEDICARE |
FL | 020050800 | Medicaid | |
FL | MR2QG | Other | BLUE CROSS BLUE SHIELD |