Provider Demographics
NPI:1396711453
Name:DICKINSON, MATTHEW G (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:G
Last Name:DICKINSON
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 1:274 UNION BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1813
Mailing Address - Country:US
Mailing Address - Phone:303-951-0600
Mailing Address - Fax:303-951-0605
Practice Address - Street 1:274 UNION BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1813
Practice Address - Country:US
Practice Address - Phone:303-951-0600
Practice Address - Fax:303-951-0605
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36756207RP1001X, 207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51632365Medicaid
WY122157400Medicaid
KS200389270AMedicaid
WA8464620Medicaid
UTZ3324Medicaid
CO29423538Medicaid
CO04594040Medicaid
OK200088630AMedicaid
OK200088630AMedicaid
COC503638Medicare PIN