Provider Demographics
NPI:1841483120
Name:BRIAN WILLOUGHBY M.D. P.C.
Entity type:Organization
Organization Name:BRIAN WILLOUGHBY M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-320-5700
Mailing Address - Street 1:255 DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4833
Mailing Address - Country:US
Mailing Address - Phone:303-320-5700
Mailing Address - Fax:303-322-6129
Practice Address - Street 1:255 DETROIT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4833
Practice Address - Country:US
Practice Address - Phone:303-320-5700
Practice Address - Fax:303-322-6129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO401152082S0099X, 207W00000X
CODR.0040115207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
463768OtherMEDICARE GROUP NUMBER
CO28836235Medicaid
C463768Medicare PIN