Basic Information
Provider Information
NPI: 1285923292
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASSING
FirstName: MATTHEW
MiddleName: ALLAN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2125 CRYSTAL GROVE DR
Address2:  
City: LAKELAND
State: FL
PostalCode: 338016875
CountryCode: US
TelephoneNumber: 8636882334
FaxNumber:  
Practice Location
Address1: 2125 CRYSTAL GROVE DR
Address2:  
City: LAKELAND
State: FL
PostalCode: 338016875
CountryCode: US
TelephoneNumber: 8636882334
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/30/2011
LastUpdateDate: 10/17/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/15/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001XA146631CAN Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
2085R0202XME119819FLY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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