Provider Demographics
NPI:1558365114
Name:BRENT, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BRENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 S DOWNING ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5855
Mailing Address - Country:US
Mailing Address - Phone:303-765-3800
Mailing Address - Fax:303-765-3804
Practice Address - Street 1:2555 S DOWNING ST
Practice Address - Street 2:SUITE 260
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5855
Practice Address - Country:US
Practice Address - Phone:303-765-3800
Practice Address - Fax:303-765-3804
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28185207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01281856Medicaid
COCO307012Medicare PIN