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NPI Code Detail

MEDICARE: MR. CHARLES BRADLEY SISSON MD

MEDICARE: MR. CHARLES BRADLEY SISSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207LP2900XPain Medicine (Anesthesiology) Physician35700CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699717181
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES BRADLEY SISSON MD
Provider Business Mailing Address
First Line : 2244 E HARMONY RD STE 100
Second Line :
City : FORT COLLINS
State : CO
Zip : 80528-3422
Country : US
Telephone Number : 970-412-5928
Fax Number : 970-632-6181
Provider Business Practice Location Address
First Line : 2244 E HARMONY RD STE 100
Second Line :
City : FORT COLLINS
State : CO
Zip : 80528-3422
Country : US
Telephone Number : 970-412-5928
Fax Number : 970-632-6181
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2006
Last Update Date : 04/18/2024

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Directions to “ MR. CHARLES BRADLEY SISSON MD” Practice Location

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