=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104820570
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROGER JOHN MATTHEWS D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2005
-----------------------------------------------------
Last Update Date | 10/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 N RUBEY DR UNIT 140
-----------------------------------------------------
City | GOLDEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80403-3214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-704-5835
-----------------------------------------------------
Fax | 720-902-3940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 N RUBEY DR UNIT 140
-----------------------------------------------------
City | GOLDEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80403-3214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-704-5835
-----------------------------------------------------
Fax | 720-902-3940
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OP61495864
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | CDRH.0037281
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------