Provider Demographics
NPI:1770644221
Name:MOLONEY, BRIAN KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KENT
Last Name:MOLONEY
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 1:447 SAGE DR
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-9608
Mailing Address - Country:US
Mailing Address - Phone:970-641-1150
Mailing Address - Fax:
Practice Address - Street 1:711 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2243
Practice Address - Country:US
Practice Address - Phone:970-641-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01311539Medicaid
COE93461Medicare UPIN
COE93461Medicare ID - Type Unspecified