Healthcare Provider Details

I. General information

NPI: 1811181357
Provider Name (Legal Business Name): GARY BROWNPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 11/29/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 CENTENNIAL BLVD # 511
COLORADO SPRINGS CO
80907-3739
US

IV. Provider business mailing address

2141 N ACADEMY CIR
COLORADO SPRINGS CO
80909-1686
US

V. Phone/Fax

Practice location:
  • Phone: 719-306-0801
  • Fax:
Mailing address:
  • Phone: 719-597-4200
  • Fax: 719-597-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39722
License Number StateCO

VIII. Authorized Official

Name: GARY BROWN
Title or Position: PRESIDENT
Credential: DO
Phone: 719-306-0801