Provider Demographics
NPI:1073593562
Name:BREYER, KLEMENTYNA M (MD)
Entity Type:Individual
Prefix:
First Name:KLEMENTYNA
Middle Name:M
Last Name:BREYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KLEMENTYNA
Other - Middle Name:M
Other - Last Name:BREYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 351750
Mailing Address - Street 2:UNION HOSPITAL
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80035
Mailing Address - Country:US
Mailing Address - Phone:303-484-8404
Mailing Address - Fax:
Practice Address - Street 1:8300 W 38TH AVE
Practice Address - Street 2:UNION HOSPITAL
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6005
Practice Address - Country:US
Practice Address - Phone:303-484-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49448207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66371881Medicaid
MD407386000Medicaid
COCOA104568Medicare PIN
MD407386000Medicaid