Healthcare Provider Details

I. General information

NPI: 1699875807
Provider Name (Legal Business Name): NORMAN ROBERT BRETHOUWER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S TOWNSEND AVE STE A
MONTROSE CO
81401-4937
US

IV. Provider business mailing address

1020 S TOWNSEND AVE STE A
MONTROSE CO
81401-4937
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-3466
  • Fax: 970-249-3468
Mailing address:
  • Phone: 970-249-3466
  • Fax: 970-249-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number15237
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: