Healthcare Provider Details

I. General information

NPI: 1558365114
Provider Name (Legal Business Name): JEFFREY BRENT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S DOWNING ST SUITE 260
DENVER CO
80210-5855
US

IV. Provider business mailing address

2555 S DOWNING ST SUITE 260
DENVER CO
80210-5855
US

V. Phone/Fax

Practice location:
  • Phone: 303-765-3800
  • Fax: 303-765-3804
Mailing address:
  • Phone: 303-765-3800
  • Fax: 303-765-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number28185
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: