Provider Demographics
NPI:1508804782
Name:MATTHES, JEFFREY DAVID (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:MATTHES
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:PO BOX 7239
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-0239
Mailing Address - Country:US
Mailing Address - Phone:402-489-9400
Mailing Address - Fax:
Practice Address - Street 1:1400 DOWELL SPRINGS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2457
Practice Address - Country:US
Practice Address - Phone:865-584-0291
Practice Address - Fax:865-584-4426
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN636892085R0202X
NE175292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100146450AMedicaid
SD7787070Medicaid
IA0521013Medicaid
NE300029831OtherRR MEDICARE
TNQ072920Medicaid
IA0521013Medicaid
F25028Medicare UPIN