MEDICARE: CHARLES O BRANTIGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	16213	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770624298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES O BRANTIGAN MD

Provider Business Mailing Address
First Line	:	2253 DOWNING ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5234
Country	:	US
Telephone Number	:	303-830-8822
Fax Number	:

Provider Business Practice Location Address
First Line	:	2253 DOWNING ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5234
Country	:	US
Telephone Number	:	303-830-8822
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES O BRANTIGAN
Credential	:	MD
Telephone Number	:	303-830-8822

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/22/2020

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