Provider Demographics
NPI:1861470577
Name:DURAN, MATTHEW GILLEN (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GILLEN
Last Name:DURAN
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 1:1321 CATALPA DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521
Mailing Address - Country:US
Mailing Address - Phone:970-223-2469
Mailing Address - Fax:
Practice Address - Street 1:1212 EAST ELIZABETH STREET
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-482-2791
Practice Address - Fax:970-495-9843
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19424033Medicaid
H73226Medicare UPIN
CO536728Medicare ID - Type Unspecified