Healthcare Provider Details

I. General information

NPI: 1760748917
Provider Name (Legal Business Name): BRENT J LEVY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRENT J LEVY MD

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4567 E. 9TH AVENUE
DENVER CO
80220-5337
US

IV. Provider business mailing address

PO BOX 173862
DENVER CO
80217-3862
US

V. Phone/Fax

Practice location:
  • Phone: 303-320-2455
  • Fax: 303-306-7753
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0054803
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: