Provider Demographics
NPI:1689631061
Name:BRECKINRIDGE, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:BRECKINRIDGE
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 1:3655 LUTHERAN PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6010
Mailing Address - Country:US
Mailing Address - Phone:303-603-9800
Mailing Address - Fax:303-403-6209
Practice Address - Street 1:3655 LUTHERAN PARKWAY
Practice Address - Street 2:SUITE # 201
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6010
Practice Address - Country:US
Practice Address - Phone:303-603-9800
Practice Address - Fax:303-403-6209
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16041207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01160415Medicaid
CO01160415Medicaid
CO68064Medicare ID - Type Unspecified