Kevin Richard Mattos, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

Marvin Shields Blvd
CBC Gulfport
Gulfport, MS 39501-0000

Phone

(850) 341-0754

Fax

(228) 871-2135

NPI assigned

May 11, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558576702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4674 CERNY RD",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325262753",
            "telephone_number": "850-341-0754",
            "fax_number": "228-871-2135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MARVIN SHIELDS BLVD",
            "address_2": "CBC GULFPORT",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395010000",
            "telephone_number": "850-341-0754",
            "fax_number": "228-871-2135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTOS",
        "first_name": "KEVIN",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lezlie Mathews, CFNP
• Analeicia Matthews
• Arthur M Matthews Jr., MD
• Sandra Matthews, NP-C
• Taylor Tubertini Mattina, PT, DPT
• Alex May, COTA
• Cheryl May, CSS
• Jennifer Boudreaux May
• Jonathan May
• Vee Dell May

• Independent Duty Corpsman in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Independent Duty Corpsman in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.