Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 28419 | CO |
NPI | 1194730689 |
---|---|
Provider Name | Mr. Brian Joseph Beatty |
First Address | Englewood, CO 80110-2129 |
Second Address | Englewood, CO 80110-2129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A65358 | (02) | CO |