Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | DR.0061091 | CO |
N | 208D00000X | General Practice Physician | 1059 | NE |
NPI | 1003176223 |
---|---|
Provider Name | Matthew Nilan |
First Address | Joint Base Lewis Mcchord, WA 98431-1000 |
Second Address | Fort Carson, CO 80913-4613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2012 |
Last Update Date | 09/11/2020 |