1033255575 NPI number — MR. MATTHEW RONALD DE BONA AP, DOM, L.AP

Table of content: DR. STEPHEN T DEBERRY PH.D. (NPI 1184687477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033255575 NPI number — MR. MATTHEW RONALD DE BONA AP, DOM, L.AP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE BONA
Provider First Name:
MATTHEW
Provider Middle Name:
RONALD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
AP, DOM, L.AP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE BONA
Provider Other First Name:
MATTHEW
Provider Other Middle Name:
RONALD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AP, DOM, L.AP,
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1033255575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5344 9TH ST STE 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZEPHYRHILLS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33542-4348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-588-2028
Provider Business Mailing Address Fax Number:
813-434-2277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5344 9TH ST STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZEPHYRHILLS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33542-4348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-588-2028
Provider Business Practice Location Address Fax Number:
813-434-2277
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AP1555 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111749000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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