MEDICARE: TRAUMA AND EMERGENCY SUBSPECIALTY SURGEONS PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)
3	208200000X	Plastic Surgery Physician
4	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	CO

General Provider Information

NPI Number	:	1740543933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAUMA AND EMERGENCY SUBSPECIALTY SURGEONS PLLC

Provider Business Mailing Address
First Line	:	1745 SHEA CENTER DR STE 400
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-1540
Country	:	US
Telephone Number	:	720-300-9245
Fax Number	:

Provider Business Practice Location Address
First Line	:	1745 SHEA CENTER DR
Second Line	:	SUITE 400
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-1537
Country	:	US
Telephone Number	:	303-774-1974
Fax Number	:

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	DR. BRIAN WILLOUGHBY
Credential	:	M.D.
Telephone Number	:	303-320-5700

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	03/07/2023

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