=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801877972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN DAVID BRAGG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2005
-----------------------------------------------------
Last Update Date | 12/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 ROCKY MOUNTAIN AVE STE 150
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-9004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-493-7442
-----------------------------------------------------
Fax | 970-493-2990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1107 S LEMAY AVE STE 300
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80524-3955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-493-7442
-----------------------------------------------------
Fax | 970-493-2990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | DR0060631
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------