MEDICARE: DR. GEORGE JOSEPH MATTIONE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	27423	CO
2	207L00000X	Anesthesiology Physician	6516	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366426165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE JOSEPH MATTIONE M.D.

Provider Business Mailing Address
First Line	:	53 CHARLOU CIR
Second Line	:
City	:	CHERRY HILLS VILLAGE
State	:	CO
Zip	:	80111-1102
Country	:	US
Telephone Number	:	720-236-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	8440 W LAKE MEAD BLVD STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7648
Country	:	US
Telephone Number	:	702-395-1070
Fax Number	:	702-395-1071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	03/03/2023

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