Provider Demographics
NPI:1063457992
Name:MONTGOMERY, MATTHEW W (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SHERMAN ST
Mailing Address - Street 2:STE 510
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-4400
Mailing Address - Country:US
Mailing Address - Phone:303-377-6825
Mailing Address - Fax:303-780-0787
Practice Address - Street 1:455 SHERMAN
Practice Address - Street 2:SUITE 510
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-4405
Practice Address - Country:US
Practice Address - Phone:303-377-6825
Practice Address - Fax:303-780-0787
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44740207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123042500Medicaid
CO18452043Medicaid
NE84113438513Medicaid
NM41306732Medicaid
KS200381030AMedicaid
MT3506685Medicaid
WY123042500Medicaid
NM41306732Medicaid
COCOA107833Medicare PIN