Provider Demographics
NPI:1720553027
Name:HEARD, MATTHEW TRACE (PA-C)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:TRACE
Last Name:HEARD
Suffix:
Gender:
Credentials:PA-C
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Mailing Address - Street 1:25073 HIGHWAY 85
Mailing Address - Street 2:
Mailing Address - City:GAY
Mailing Address - State:GA
Mailing Address - Zip Code:30218-1237
Mailing Address - Country:US
Mailing Address - Phone:770-639-2416
Mailing Address - Fax:478-352-0095
Practice Address - Street 1:715 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4209
Practice Address - Country:US
Practice Address - Phone:970-252-2800
Practice Address - Fax:970-240-7330
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA009061363A00000X
COPA.0009025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant