Provider Demographics
NPI:1407945595
Name:BRUNDIGE, RICHARD LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEWIS
Last Name:BRUNDIGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8015 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 050
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3075
Mailing Address - Country:US
Mailing Address - Phone:303-237-0086
Mailing Address - Fax:303-237-6112
Practice Address - Street 1:8015 W ALAMEDA AVE
Practice Address - Street 2:SUITE 050
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3075
Practice Address - Country:US
Practice Address - Phone:303-237-0086
Practice Address - Fax:303-237-6112
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19240207Q00000X
AZ7791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO249201OtherCIGNA
CO802928OtherAETNA
CO79204OtherBLUE CROSS SHIELD
CO79204OtherBLUE CROSS SHIELD
D23564Medicare UPIN