Healthcare Provider Details

I. General information

NPI: 1073386611
Provider Name (Legal Business Name): BRANDON GUZIE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14255 DENVER WEST CIR APT 5301
LAKEWOOD CO
80401-3355
US

IV. Provider business mailing address

14255 DENVER WEST CIR APT 5301
LAKEWOOD CO
80401-3355
US

V. Phone/Fax

Practice location:
  • Phone: 904-226-0492
  • Fax:
Mailing address:
  • Phone: 904-226-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0008238
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: