Healthcare Provider Details

I. General information

NPI: 1376453225
Provider Name (Legal Business Name): BRIAN ANDREW VALLEY SOIDC/PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 WETZEL AVE
FT CARSON CO
80913-4156
US

IV. Provider business mailing address

6105 WETZEL AVE
FT CARSON CO
80913-4156
US

V. Phone/Fax

Practice location:
  • Phone: 719-503-0650
  • Fax:
Mailing address:
  • Phone: 719-503-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License NumberM5200187
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: