Healthcare Provider Details

I. General information

NPI: 1225274145
Provider Name (Legal Business Name): MATTHEW I. EHRLICH, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 SAINT MICHAELS DR BUILDING A
SANTA FE NM
87505-7620
US

IV. Provider business mailing address

4263 PORTOFINO DRIVE
LONGMONT CO
80503
US

V. Phone/Fax

Practice location:
  • Phone: 505-954-4442
  • Fax:
Mailing address:
  • Phone: 720-652-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD2008-0788
License Number StateNM

VIII. Authorized Official

Name: MATTHEW IAN EHRLICH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 720-652-0224