Provider Demographics
NPI:1295982700
Name:CLOSE, MATTHEW ALAN (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALAN
Last Name:CLOSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6179 S BALSAM WAY STE 250
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3091
Mailing Address - Country:US
Mailing Address - Phone:720-603-8178
Mailing Address - Fax:720-603-8179
Practice Address - Street 1:6179 S BALSAM WAY STE 250
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3091
Practice Address - Country:US
Practice Address - Phone:720-603-8178
Practice Address - Fax:720-603-8179
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11396207P00000X
SC1422207PS0010X
CODR.0057432207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC014228Medicaid
SCSC00147951Medicare PIN