Provider Demographics
NPI:1962503284
Name:BRAD CULBERSON, MD PC
Entity Type:Organization
Organization Name:BRAD CULBERSON, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CULBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-798-1309
Mailing Address - Street 1:15 W DRY CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4427
Mailing Address - Country:US
Mailing Address - Phone:303-798-1309
Mailing Address - Fax:303-798-2319
Practice Address - Street 1:15 W DRY CREEK CIR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4427
Practice Address - Country:US
Practice Address - Phone:303-798-1309
Practice Address - Fax:303-798-2319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC459128Medicare ID - Type Unspecified