Provider Demographics
NPI:1285610964
Name:BRETT, MATTHEW S (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:BRETT
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 1:303 MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:LYONS
Mailing Address - State:CO
Mailing Address - Zip Code:80540
Mailing Address - Country:US
Mailing Address - Phone:303-823-6535
Mailing Address - Fax:
Practice Address - Street 1:220 E ROGERS RD
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6027
Practice Address - Country:US
Practice Address - Phone:303-286-4560
Practice Address - Fax:303-286-4589
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65083857Medicaid
COCOA101930Medicare PIN
CO65083857Medicaid