Healthcare Provider Details

I. General information

NPI: 1275765802
Provider Name (Legal Business Name): MATTHEW P OROURKE MATTHEW O'ROURKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2009
Last Update Date: 10/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 OLD LARAMIE TRL E
LAFAYETTE CO
80026-7012
US

IV. Provider business mailing address

120 OLD LARAMIE TRL E
LAFAYETTE CO
80026-7012
US

V. Phone/Fax

Practice location:
  • Phone: 303-926-9800
  • Fax: 303-926-9801
Mailing address:
  • Phone: 303-926-9800
  • Fax: 303-926-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: