Provider Demographics
NPI:1972505220
Name:JEPSON, BRETT R (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:R
Last Name:JEPSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1644 MEDICAL CENTER PT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5764
Mailing Address - Country:US
Mailing Address - Phone:719-634-1994
Mailing Address - Fax:719-634-2906
Practice Address - Street 1:1644 MEDICAL CENTER PT
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5764
Practice Address - Country:US
Practice Address - Phone:719-634-1994
Practice Address - Fax:719-634-2906
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2020-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO0055168208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11429385Medicare UPIN
NE273824Medicare ID - Type Unspecified