Provider Demographics
NPI:1790751360
Name:LEWIS, MATTHEW RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RICHARD
Last Name:LEWIS
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 1:2230 S FRASER ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4535
Mailing Address - Country:US
Mailing Address - Phone:303-341-4200
Mailing Address - Fax:303-341-4200
Practice Address - Street 1:2230 S FRASER ST
Practice Address - Street 2:UNIT 1
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4535
Practice Address - Country:US
Practice Address - Phone:303-341-4200
Practice Address - Fax:303-341-4200
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01355346Medicaid
D0948Medicare ID - Type Unspecified
G36196Medicare UPIN