Provider Demographics
NPI:1881644649
Name:GIESZL, BRYAN C (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:C
Last Name:GIESZL
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 1:300 S NEVADA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401
Mailing Address - Country:US
Mailing Address - Phone:970-249-7751
Mailing Address - Fax:970-249-5029
Practice Address - Street 1:300 S NEVADA AVENUE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401
Practice Address - Country:US
Practice Address - Phone:970-249-7751
Practice Address - Fax:970-249-5029
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57428361Medicaid
COC807035OtherMONTROSE MEMORIAL HOSPITAL MEDICARE PIN
COI53306Medicare UPIN
COC807035OtherMONTROSE MEMORIAL HOSPITAL MEDICARE PIN