MEDICARE: BRETT K MATHESON M.D., FACMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	DR.0035631	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427043579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT K MATHESON M.D., FACMS

Provider Business Mailing Address
First Line	:	1975 RESEARCH PKWY STE 165
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80920-1026
Country	:	US
Telephone Number	:	719-574-0310
Fax Number	:	719-593-5947

Provider Business Practice Location Address
First Line	:	1975 RESEARCH PKWY STE 165
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80920-1026
Country	:	US
Telephone Number	:	719-574-0310
Fax Number	:	719-574-6574

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	01/10/2025

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