Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD00046553 | WA |
N | 208600000X | Surgeon | MD00046553 | WA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | DR.0054039 | CO |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD00046553 | WA |
NPI | 1194761833 |
---|---|
Provider Name | Dr. David Woodbridge Mathes |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-2545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 30/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G89516 | (02) | WA |