Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 49752 | CO |
NPI | 1285839928 |
---|---|
Provider Name | Dr. Matthew John Mahlberg |
First Address | Centennial, CO 80111-1724 |
Second Address | Centennial, CO 80111-1724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 02/08/2016 |