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General NPI Number Information
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NPI Number | 1194266809
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Entity Type | Organization
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Legal Business Name | BRIAR ROSE MEDICAL GROUP,LLC
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 11/08/2017
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Provider Practice Location Address
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Address Line | 3350 PEORIA ST STE 120
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City | AURORA
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State | CO
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Zip | 80010-1483
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Country | US
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Telephone | 844-355-7673
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Fax | 720-729-8100
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Provider Business Mailing Address
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Address Line | 3350 PEORIA ST STE 120
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City | AURORA
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State | CO
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Zip | 80010-1483
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Country | US
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Telephone | 844-355-7673
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Fax | 720-729-8100
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. MATTHEW CARSON PONDER
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Credential | MD
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Telephone | 844-355-7673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 0054605
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License Number State | CO
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