Healthcare Provider Details

I. General information

NPI: 1073519401
Provider Name (Legal Business Name): MATTHEW PAUL NOWLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W 8TH AVE
YUMA CO
80759-2641
US

IV. Provider business mailing address

1000 W 8TH AVE
YUMA CO
80759-2641
US

V. Phone/Fax

Practice location:
  • Phone: 970-848-5405
  • Fax: 970-848-5475
Mailing address:
  • Phone: 970-848-5405
  • Fax: 970-848-5475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number464198
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: