Provider Demographics
NPI:1073519401
Name:NOWLAND, MATTHEW PAUL (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
Last Name:NOWLAND
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 1:1000 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:CO
Mailing Address - Zip Code:80759-2641
Mailing Address - Country:US
Mailing Address - Phone:970-848-5405
Mailing Address - Fax:970-848-5475
Practice Address - Street 1:1000 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:CO
Practice Address - Zip Code:80759-2641
Practice Address - Country:US
Practice Address - Phone:970-848-5405
Practice Address - Fax:970-848-5475
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO464198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33827087Medicaid
WAG8867053OtherMEDICARE GROUP
WA8473076Medicaid
H60102Medicare UPIN
CO464198Medicare ID - Type Unspecified
CO33827087Medicaid
WAG8868139Medicare PIN