Healthcare Provider Details

I. General information

NPI: 1639353485
Provider Name (Legal Business Name): BRIDGET MARIE BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIDGET MARIE JACKSON

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 E 15TH ST
LOVELAND CO
80538-8938
US

IV. Provider business mailing address

2555 E 13TH ST SUITE 130
LOVELAND CO
80537-5161
US

V. Phone/Fax

Practice location:
  • Phone: 970-313-2700
  • Fax: 970-669-7521
Mailing address:
  • Phone: 970-663-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6805153
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47521
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: