Provider Demographics
NPI:1508864455
Name:BREEDEN, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BREEDEN
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 1:1601 E 19TH AVE
Mailing Address - Street 2:SUITE 4200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218
Mailing Address - Country:US
Mailing Address - Phone:303-861-4914
Mailing Address - Fax:303-861-8615
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 4200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218
Practice Address - Country:US
Practice Address - Phone:303-861-4914
Practice Address - Fax:303-861-8615
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40066207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34307532Medicaid
CO68758332Medicaid
COH55908Medicare UPIN
CO810242Medicare PIN
CO68758332Medicaid
CO39268Medicare PIN