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General NPI Number Information
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NPI Number | 1720553027
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Entity Type | Individual
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Provider Name | MATTHEW TRACE HEARD PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 715 S 3RD ST
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City | MONTROSE
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State | CO
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Zip | 81401-4209
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Country | US
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Telephone | 970-252-2800
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Fax | 970-240-7330
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Provider Business Mailing Address
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Address Line | 25073 HIGHWAY 85
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City | GAY
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State | GA
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Zip | 30218-1237
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Country | US
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Telephone | 770-639-2416
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Fax | 478-352-0095
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 009061
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0009025
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License Number State | CO
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