Provider Demographics
NPI:1336522820
Name:LEVY, BRYAN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 MOUNTAIN VIEW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3180
Mailing Address - Country:US
Mailing Address - Phone:720-652-8444
Mailing Address - Fax:720-652-8445
Practice Address - Street 1:2030 MOUNTAIN VIEW AVE STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3180
Practice Address - Country:US
Practice Address - Phone:720-652-8444
Practice Address - Fax:720-652-8445
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021893208600000X
CODR.0065455208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery