Provider Demographics
NPI:1649259508
Name:WEGNER, BRIAN KEITH (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:WEGNER
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 1:8585 W 14TH AVE
Mailing Address - Street 2:SUITE B2
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4857
Mailing Address - Country:US
Mailing Address - Phone:303-238-1201
Mailing Address - Fax:303-238-2981
Practice Address - Street 1:8585 W 14TH AVE
Practice Address - Street 2:SUITE B2
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4857
Practice Address - Country:US
Practice Address - Phone:303-238-1201
Practice Address - Fax:303-238-2981
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2591992OtherCIGNA
CO7989592OtherAETNA
CO841365302044OtherRKY MTN HMO
CO1649259508OtherNPI #
CO513142OtherMEDICARE GROUP NUMBER
P00381353OtherRAILROAD MEDICARE
CO04020541OtherMEDICAID GROUP #
CO84136530247OtherPACIFICARE
COWE671478OtherANTHEM BCBS
CO1215981634OtherGROUP NPI #
CO84136530247OtherPACIFICARE PPO
CTRO103008OtherGROUP ANTHEM BCBS
CO56339763Medicaid
COWE671478OtherANTHEM BCBS
CTRO103008OtherGROUP ANTHEM BCBS
CO513230ZVTAMedicare PIN