Healthcare Provider Details

I. General information

NPI: 1508971680
Provider Name (Legal Business Name): BRIAN JOSEPH MONROE CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 24TH ST NW STE 5
WASHINGTON DC
20037-2543
US

IV. Provider business mailing address

730 24TH ST NW STE 5
WASHINGTON DC
20037-2543
US

V. Phone/Fax

Practice location:
  • Phone: 202-338-0770
  • Fax: 202-315-3176
Mailing address:
  • Phone: 202-338-0770
  • Fax: 202-315-3176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number1705
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: