Provider Demographics
NPI:1629051313
Name:BRADY, FRED C (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:C
Last Name:BRADY
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 1:3033 S PARKER RD
Mailing Address - Street 2:STE 800
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2910
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:3033 S PARKER RD
Practice Address - Street 2:STE 800
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2910
Practice Address - Country:US
Practice Address - Phone:303-306-7783
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19367207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01193671Medicaid
COE50100Medicare ID - Type Unspecified
CO01193671Medicaid