Provider Demographics
NPI:1174524011
Name:MATESE, ANNE MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MARIE
Last Name:MATESE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3365 BURNS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4302
Mailing Address - Country:US
Mailing Address - Phone:561-626-4000
Mailing Address - Fax:561-493-8172
Practice Address - Street 1:2676 SW IMMANUEL DR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2738
Practice Address - Country:US
Practice Address - Phone:772-219-4444
Practice Address - Fax:561-493-8172
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 06735208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80926OtherBLUE CROSS BLUE SHIELD