Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DR.0034519 | CO |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 34519 | CO |
NPI | 1194855734 |
---|---|
Provider Name | Dr. Brian Neal Mathwich |
First Address | Longmont, CO 80501-6036 |
Second Address | Longmont, CO 80501-6036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 30/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F7783-9 | (02) | CO |