Provider Demographics
NPI:1619038908
Name:MATTHEWS, JON S (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:S
Last Name:MATTHEWS
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 1:2815 DIXON CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6263
Mailing Address - Country:US
Mailing Address - Phone:970-223-1461
Mailing Address - Fax:
Practice Address - Street 1:HARTSHORN HEALTH SERVICE
Practice Address - Street 2:COLORADO STATE UNIVERSITY
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-0001
Practice Address - Country:US
Practice Address - Phone:970-491-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF77168Medicare UPIN