Provider Demographics
NPI:1619077427
Name:BRASHEAR, SUSAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:BRASHEAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10099 RIDGEGATE PKWY
Mailing Address - Street 2:SUITE 290
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5531
Mailing Address - Country:US
Mailing Address - Phone:303-791-2112
Mailing Address - Fax:303-683-6415
Practice Address - Street 1:10099 RIDGEGATE PKWY
Practice Address - Street 2:SUITE 290
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5531
Practice Address - Country:US
Practice Address - Phone:303-791-2112
Practice Address - Fax:303-683-6415
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42930207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09602721Medicaid
CO810212OtherMEDICARE GROUP PTAN
CO76580237OtherMEDICAID GROUP NUMBER
CO348308OtherMEDICARE GROUP NUMBER
COC810212OtherMEDICARE GROUP NUMBER
CO47688343OtherMEDICAID PRACTICE NUMBER
CO810249Medicare PIN
CO76580237OtherMEDICAID GROUP NUMBER
CO810212OtherMEDICARE GROUP PTAN