Provider Demographics
NPI:1891048682
Name:RIED, MATTHEW D (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:RIED
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6337 SHOOTING IRON WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7403
Mailing Address - Country:US
Mailing Address - Phone:520-456-4910
Mailing Address - Fax:
Practice Address - Street 1:6337 SHOOTING IRON WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-7403
Practice Address - Country:US
Practice Address - Phone:520-456-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant