Provider Demographics
NPI:1609195676
Name:PRIEBE, BRAD JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:JOSEPH
Last Name:PRIEBE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13010 TAHOSA LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-3251
Mailing Address - Country:US
Mailing Address - Phone:269-209-7019
Mailing Address - Fax:
Practice Address - Street 1:5770 FLINTRIDGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1881
Practice Address - Country:US
Practice Address - Phone:517-353-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00540252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology