Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 28542 | CO |
NPI | 1073501292 |
---|---|
Provider Name | David Scott Brantley |
First Address | Greenwood Village, CO 80111-4723 |
Second Address | Colorado Springs, CO 80907-5320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 24/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14507552 | (05) | CO |
E17793 | (02) |