Healthcare Provider Details

I. General information

NPI: 1952739427
Provider Name (Legal Business Name): MATTHEW J FURMAN, D.O. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W D ST SUITE 210 A
PUEBLO CO
81003-3461
US

IV. Provider business mailing address

112 W D ST SUITE 210 A
PUEBLO CO
81003-3461
US

V. Phone/Fax

Practice location:
  • Phone: 719-543-7877
  • Fax: 719-543-7882
Mailing address:
  • Phone: 719-543-7877
  • Fax: 719-543-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number41522
License Number StateCO

VIII. Authorized Official

Name: DR. MATTHEW J FURMAN
Title or Position: DO
Credential: D.O.
Phone: 719-543-7877