Provider Demographics
NPI:1962876029
Name:EARL, MATTHEW L (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:L
Last Name:EARL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 800022
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0022
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:17230 JACKSON CREEK PKWY STE 300
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7306
Practice Address - Country:US
Practice Address - Phone:719-571-7000
Practice Address - Fax:719-571-7059
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2024-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0062857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029054OtherKAISER COMMERCIAL NUMBER