Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 000767 | CO |
NPI | 1104128339 |
---|---|
Provider Name | Dr. Matthew Reed Thomas |
First Address | Colorado Springs, CO 80920 |
Second Address | Colorado Springs, CO 80920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2010 |
Last Update Date | 29/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12415184 | CAQH (01) | CO |
97005070 | (05) | CO |
GH1252 | (02) | CO |