Provider Demographics
NPI:1639609894
Name:DYNAMIC FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:DYNAMIC FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-392-3883
Mailing Address - Street 1:5715 KITTERY DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3551
Mailing Address - Country:US
Mailing Address - Phone:719-392-3883
Mailing Address - Fax:719-390-6338
Practice Address - Street 1:5715 KITTERY DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-3551
Practice Address - Country:US
Practice Address - Phone:719-392-3883
Practice Address - Fax:719-390-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty