Provider Demographics
NPI:1487659181
Name:BRANT, DENNIS P
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:P
Last Name:BRANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DENNIS
Other - Middle Name:P
Other - Last Name:BRANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 912215
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-2215
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:1024 S LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3929
Practice Address - Country:US
Practice Address - Phone:970-495-7000
Practice Address - Fax:970-495-7611
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003152207P00000X, 363A00000X
IA001120363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS60341Medicare UPIN
IAI4967Medicare ID - Type Unspecified