Provider Demographics
NPI:1639353485
Name:BROWN, BRIDGET MARIE (MD)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:MARIE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2555 E 13TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5161
Mailing Address - Country:US
Mailing Address - Phone:970-663-5437
Mailing Address - Fax:
Practice Address - Street 1:3520 E 15TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8938
Practice Address - Country:US
Practice Address - Phone:970-313-2700
Practice Address - Fax:970-669-7521
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6805153208000000X
CO47521208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93451385Medicaid
COCOA102538Medicare PIN