Healthcare Provider Details

I. General information

NPI: 1124428644
Provider Name (Legal Business Name): MATTHEW PAUL EDWARDS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 W 26TH AVE STE 300A
DENVER CO
80211-5321
US

IV. Provider business mailing address

2490 W 26TH AVE STE 300A
DENVER CO
80211-5321
US

V. Phone/Fax

Practice location:
  • Phone: 303-831-9393
  • Fax: 303-831-6335
Mailing address:
  • Phone: 303-831-9393
  • Fax: 303-831-6335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0004051
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: