Basic Information
| Provider Information | |||||||||
| NPI: | 1518279868 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROWAN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | JERALD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 HEALTH PARK DR | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800279583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034229438 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1819 DENVER WEST DR | ||||||||
| Address2: | |||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804013118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034229438 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2010 | ||||||||
| LastUpdateDate: | 11/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | DR.00053557 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 66083320 | 05 | CO | MEDICAID |