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General NPI Number Information
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NPI Number | 1962425710
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Entity Type | Individual
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Provider Name | BRIAN J WILLOUGHBY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 3150 E 3RD AVE STE 100
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City | DENVER
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State | CO
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Zip | 80206-5248
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Country | US
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Telephone | 303-320-5700
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Fax | 303-322-6129
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Provider Business Mailing Address
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Address Line | 3150 E 3RD AVE STE 100
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City | DENVER
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State | CO
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Zip | 80206-5248
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Country | US
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Telephone | 303-320-5700
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Fax | 303-322-6129
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 40115
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | DR.0040115
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License Number State | CO
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