Provider Demographics
NPI:1902816556
Name:LEDGES, MATTHEW G (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:LEDGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:LEDGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3600 E ALAMEDA #100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209
Mailing Address - Country:US
Mailing Address - Phone:720-266-6789
Mailing Address - Fax:720-266-6935
Practice Address - Street 1:3600 E ALAMEDA #100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209
Practice Address - Country:US
Practice Address - Phone:720-266-6789
Practice Address - Fax:720-266-6935
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46017207PE0004X, 207P00000X
CO1348363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP28889Medicare UPIN
CO177418Medicare ID - Type Unspecified