Healthcare Provider Details

I. General information

NPI: 1790751360
Provider Name (Legal Business Name): MATTHEW RICHARD LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 S FRASER ST UNIT 1
AURORA CO
80014-4535
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 303-341-4200
  • Fax: 303-341-4200
Mailing address:
  • Phone: 719-463-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35534
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: