Provider Demographics
NPI:1124428644
Name:EDWARDS, MATTHEW PAUL (PA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 W 26TH AVE STE 300A
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5321
Mailing Address - Country:US
Mailing Address - Phone:303-831-9393
Mailing Address - Fax:303-831-6335
Practice Address - Street 1:2490 W 26TH AVE STE 300A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5321
Practice Address - Country:US
Practice Address - Phone:303-831-9393
Practice Address - Fax:303-831-6335
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004051363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant