Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 061080 | GA |
N | 207RA0201X | Internist - Allergy & Immunology | 4301088191 | MI |
N | 208000000X | Pediatrician | 4301088191 | MI |
Y | 2080P0201X | Pediatric Allergist | DR.0055929 | CO |
NPI | 1932226644 |
---|---|
Provider Name | Dr. Matthew Jason Greenhawt |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 21/07/2020 |