Provider Demographics
NPI:1972829737
Name:GEORGE, BRENDA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:MARIE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2315 E HARMONY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8620
Mailing Address - Country:US
Mailing Address - Phone:970-482-4373
Mailing Address - Fax:970-484-5682
Practice Address - Street 1:2315 E HARMONY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8620
Practice Address - Country:US
Practice Address - Phone:970-482-4373
Practice Address - Fax:970-484-5682
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.00540582084N0400X
WYTL28012084N0400X
WY9956A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65750110Medicaid
WY1972829737Medicaid
WY1972829737Medicaid
WYW26599Medicare PIN