Healthcare Provider Details

I. General information

NPI: 1841483120
Provider Name (Legal Business Name): BRIAN WILLOUGHBY M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 DETROIT ST
DENVER CO
80206-4833
US

IV. Provider business mailing address

255 DETROIT ST
DENVER CO
80206-4833
US

V. Phone/Fax

Practice location:
  • Phone: 303-320-5700
  • Fax: 303-322-6129
Mailing address:
  • Phone: 303-320-5700
  • Fax: 303-322-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number40115
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberDR.0040115
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number40115
License Number StateCO

VIII. Authorized Official

Name: BRIAN WILLOUGHBY
Title or Position: OWNER
Credential: M.D.
Phone: 303-320-5700