Healthcare Provider Details

I. General information

NPI: 1750357414
Provider Name (Legal Business Name): BRIAN GRABERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 MEDICAL CENTER PT
COLORADO SPRINGS CO
80907-8732
US

IV. Provider business mailing address

1633 MEDICAL CENTER PT
COLORADO SPRINGS CO
80907-8732
US

V. Phone/Fax

Practice location:
  • Phone: 719-578-8666
  • Fax: 719-667-4218
Mailing address:
  • Phone: 719-578-8666
  • Fax: 719-667-4218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License NumberDR0020448
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number20448
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: