Healthcare Provider Details

I. General information

NPI: 1306914031
Provider Name (Legal Business Name): BRETT COLDIRON, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 BURNET AVE
CINCINNATI OH
45219-2420
US

IV. Provider business mailing address

200 NORTHLAND BLVD FL 1
CINCINNATI OH
45246-3604
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-2828
  • Fax:
Mailing address:
  • Phone: 513-672-4128
  • Fax: 513-672-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRETT COLDIRON
Title or Position: PRESIDENT
Credential:
Phone: 513-221-2828