Healthcare Provider Details

I. General information

NPI: 1912085952
Provider Name (Legal Business Name): ANN LOUISE MATTSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 UCB
BOULDER CO
80309-0119
US

IV. Provider business mailing address

3298 95TH ST
BOULDER CO
80301-4930
US

V. Phone/Fax

Practice location:
  • Phone: 303-492-2040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number31282
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: