Healthcare Provider Details

I. General information

NPI: 1770624298
Provider Name (Legal Business Name): CHARLES O BRANTIGAN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2253 DOWNING ST
DENVER CO
80205-5234
US

IV. Provider business mailing address

2253 DOWNING ST
DENVER CO
80205-5234
US

V. Phone/Fax

Practice location:
  • Phone: 303-830-8822
  • Fax:
Mailing address:
  • Phone: 303-830-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number16213
License Number StateCO

VIII. Authorized Official

Name: DR. CHARLES O BRANTIGAN
Title or Position: OWNER
Credential: MD
Phone: 303-830-8822