GIPSON, MATTHEW (MD)

Provider Demographics

• NPI: 1255431235
• Name: GIPSON, MATTHEW (MD)
• Entity type: Individual
• First Name: MATTHEW
• Last Name: GIPSON
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 10800 E GEDDES AVE STE 300
• Mailing Address - City: ENGLEWOOD
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80112-3895
• Mailing Address - Country: US
• Mailing Address - Phone: 303-761-9190
• Mailing Address - Fax: 720-874-4462
• Practice Address - Street 1: 10800 E GEDDES AVE STE 300
• Practice Address - City: ENGLEWOOD
• Practice Address - State: CO
• Practice Address - Zip Code: 80112-3895
• Practice Address - Country: US
• Practice Address - Phone: 303-761-9190
• Practice Address - Fax: 720-874-4462
• Is Sole Proprietor?: No
• Enumeration Date: 2006-09-22
• Last Update Date: 2023-11-17

Provider Licenses

State	License ID	Taxonomies
KS	04-38597	2085R0202X
NE	28964	2085R0202X
CO	DR.0048923	2085R0204X
CO	48923	2085R0202X
HI	MD18441	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0204X	Allopathic & Osteopathic Physicians	Radiology	Vascular & Interventional Radiology
No	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CO	98071831	Medicaid
NE	10026277400	Medicaid
NE	10026277800	Medicaid
OK	200620590A	Medicaid
CO	P01599148	Other	RIA RR MEDICARE
NE	10025709000	Medicaid
NE	10026277600	Medicaid
UT	1255431235	Medicaid
NE	84059792913	Medicaid
NE	10026277300	Medicaid
NE	10026277500	Medicaid
KS	201123570A	Medicaid
NE	10026277700	Medicaid
NE	84089712600	Medicaid
NE	P01646276	Other	RAILROAD MEDICARE RIN
NE	10026277600	Medicaid
CO	COA101595	Medicare PIN
CO	445402YQN9	Medicare PIN
NE	P01646276	Other	RAILROAD MEDICARE RIN
NE	10026277700	Medicaid
OK	200620590A	Medicaid
NE	10025709000	Medicaid
NE	84059792913	Medicaid
CO	445402YQ3L	Medicare PIN
CO	445402YQ33	Medicare PIN
CO	445402YQPG	Medicare PIN