Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 05-39569 | KS |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 34.011728 | OH |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | DR0052455 | CO |
NPI | 1154577856 |
---|---|
Provider Name | Dr. Brean Drew Mccarthy |
First Address | Ft Carson, CO 80913-4613 |
Second Address | Glasgow, MT 59230-2422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2008 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10429867 | (05) | CO |