MEDICARE: BRETT COLBY CLARK 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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1740034990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT COLBY CLARK MD

Provider Business Mailing Address
First Line	:	601 E HAMPDEN AVE STE 470
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-2797
Country	:	US
Telephone Number	:	303-788-3150
Fax Number	:	303-788-3199

Provider Business Practice Location Address
First Line	:	601 E HAMPDEN AVE STE 470
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-2797
Country	:	US
Telephone Number	:	303-788-3100
Fax Number	:	303-788-3199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	06/02/2026

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