Provider Demographics
NPI:1366426165
Name:MATTIONE, GEORGE JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOSEPH
Last Name:MATTIONE
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 1:53 CHARLOU CIR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILLS VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1102
Mailing Address - Country:US
Mailing Address - Phone:720-236-8500
Mailing Address - Fax:
Practice Address - Street 1:8440 W LAKE MEAD BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7648
Practice Address - Country:US
Practice Address - Phone:702-395-1070
Practice Address - Fax:702-395-1071
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27423207L00000X
NV6516207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505641Medicaid
CO01274232Medicaid
028411Medicare UPIN