Healthcare Provider Details

I. General information

NPI: 1225947021
Provider Name (Legal Business Name): BRANDON MALONE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6873 SNOWSHOE TRL
EVERGREEN CO
80439-6829
US

IV. Provider business mailing address

6873 SNOWSHOE TRL
EVERGREEN CO
80439-6829
US

V. Phone/Fax

Practice location:
  • Phone: 720-666-0970
  • Fax:
Mailing address:
  • Phone: 720-666-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ191289
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: