Individual
MATTHEW EMMETT HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1625 FOXTRAIL DR STE 190, LOVELAND, CO 80538-9089
(970) 619-6900
Mailing address
1625 FOXTRAIL DR STE 190, LOVELAND, CO 80538-9089
(970) 619-6900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3030
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017155
KAISER COMMERCIAL NUMBER
CO
01
—
3030
STATE LICENSE
CO
05
—
33388270
—
CO
Enumeration date
09/08/2010
Last updated
01/15/2020
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