Provider Demographics
NPI:1225588221
Name:TRAUMA AND EMERGENCY SUBSPECIALTY SURGEONS PLLC
Entity Type:Organization
Organization Name:TRAUMA AND EMERGENCY SUBSPECIALTY SURGEONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-320-5700
Mailing Address - Street 1:1745 SHEA CENTER DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-1537
Mailing Address - Country:US
Mailing Address - Phone:303-774-1974
Mailing Address - Fax:
Practice Address - Street 1:1745 SHEA CENTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-1537
Practice Address - Country:US
Practice Address - Phone:303-774-1974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223S0112X
CO40115204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty