Provider Demographics
NPI:1235824863
Name:GWOST, MATT (EMS)
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:
Last Name:GWOST
Suffix:
Gender:M
Credentials:EMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5464
Mailing Address - Street 2:
Mailing Address - City:SNOWMASS VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:81615-5464
Mailing Address - Country:US
Mailing Address - Phone:970-904-0518
Mailing Address - Fax:
Practice Address - Street 1:2727 COUNTY ROAD 100
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-9534
Practice Address - Country:US
Practice Address - Phone:970-904-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COE3458714207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty