Healthcare Provider Details

I. General information

NPI: 1740327014
Provider Name (Legal Business Name): MATTHEW M LANGSTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 G RD STE 160
GRAND JCT CO
81505-1003
US

IV. Provider business mailing address

PO BOX 1727
GRAND JUNCTION CO
81502-1727
US

V. Phone/Fax

Practice location:
  • Phone: 970-644-3250
  • Fax: 970-644-3916
Mailing address:
  • Phone: 970-263-2619
  • Fax: 970-263-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number45961
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number45961
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number45961
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: