Basic Information
| Provider Information | |||||||||
| NPI: | 1902816556 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEDGES | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LEDGES | ||||||||
| OtherFirstName: | MATT | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3600 E ALAMEDA #100 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202666789 | ||||||||
| FaxNumber: | 7202666935 | ||||||||
| Practice Location | |||||||||
| Address1: | 3600 E ALAMEDA #100 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202666789 | ||||||||
| FaxNumber: | 7202666935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 02/27/2008 | ||||||||
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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 | 207PE0004X | 46017 | CO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 363A00000X | 1348 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207P00000X | 46017 | CO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.