Provider Demographics
NPI:1811066996
Name:MATTHEWS, RICHARD SMITH JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SMITH
Last Name:MATTHEWS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:245 W AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-2254
Mailing Address - Country:US
Mailing Address - Phone:850-475-3726
Mailing Address - Fax:
Practice Address - Street 1:1337 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3451
Practice Address - Country:US
Practice Address - Phone:850-932-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42669207Q00000X
NC200900283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17624VMedicare PIN
FLC78766Medicare UPIN