Healthcare Provider Details

I. General information

NPI: 1710055140
Provider Name (Legal Business Name): DAVID ELLIOTT BRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 THORNBIRD PL
BOULDER CO
80304-2496
US

IV. Provider business mailing address

2607 THORNBIRD PL
BOULDER CO
80304-2496
US

V. Phone/Fax

Practice location:
  • Phone: 772-285-8215
  • Fax:
Mailing address:
  • Phone: 772-285-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberFLME0035746
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberFLME0035746
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number45929
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: