Provider Demographics
NPI:1134148067
Name:MATOS, RICARDO LUIS (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:LUIS
Last Name:MATOS
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 1:1821 NE 25TH ST
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7744
Mailing Address - Country:US
Mailing Address - Phone:954-942-0321
Mailing Address - Fax:954-946-7018
Practice Address - Street 1:1821 NE 25TH ST
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7744
Practice Address - Country:US
Practice Address - Phone:954-942-0321
Practice Address - Fax:954-946-7018
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90399174400000X
PAMD417760207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0502872OtherGHI
FL50209OtherBC/BS
FL0502872OtherGHI
FLH90491Medicare UPIN