Provider Demographics
NPI:1720265846
Name:TERRA, MATTHEW G (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:G
Last Name:TERRA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:STE 3700
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1216
Mailing Address - Country:US
Mailing Address - Phone:303-831-4774
Mailing Address - Fax:303-839-7750
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:STE 3700
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-831-4774
Practice Address - Fax:303-839-7750
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2024-10-25
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Provider Licenses
StateLicense IDTaxonomies
CODR0036795207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36795OtherLICENSE
CO42406846Medicaid
CO42406846Medicaid
COC52104Medicare PIN