Provider Demographics
NPI:1033174446
Name:BRUNWORTH, GRETCHEN (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:BRUNWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1390 S POTOMAC ST
Mailing Address - Street 2:STE 128
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4529
Mailing Address - Country:US
Mailing Address - Phone:303-341-4785
Mailing Address - Fax:303-341-1479
Practice Address - Street 1:830 POTOMAC CIR
Practice Address - Street 2:SUITE 209
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6750
Practice Address - Country:US
Practice Address - Phone:303-341-4785
Practice Address - Fax:303-341-1479
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO32695208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01326958Medicaid
COCD9218Medicare PIN
CO01326958Medicaid