Provider Demographics
NPI:1861440729
Name:GERLACH, MATTHEW R (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:GERLACH
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 1:2500 E PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9718
Mailing Address - Country:US
Mailing Address - Phone:970-493-0112
Mailing Address - Fax:970-493-0521
Practice Address - Street 1:1610 DRY CREEK DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6405
Practice Address - Country:US
Practice Address - Phone:303-772-1600
Practice Address - Fax:970-493-0521
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0044589207XS0117X
MN49522207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1861440729Medicaid
WI34784600Medicaid
CO83807268Medicaid
MNP00437483OtherRR MEDICARE
MN1051669OtherPREFERRED ONE
MN1861440729OtherAMERICAS PPO
MN173D3GEOtherBLUE CROSS & BLUE SHIELD
MN1861440729OtherMEDICA
MN139604OtherUCARE
MN277175000Medicaid
CO83807268Medicaid
WI491750012Medicare PIN
WI34784600Medicaid
MNP00437483OtherRR MEDICARE
MNHP78810OtherHEALTH PARTNERS