Provider Demographics
NPI:1952432155
Name:ENGLUND, BRETT M (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:M
Last Name:ENGLUND
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 1:2790 N ACADEMY BLVD STE 229
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5328
Mailing Address - Country:US
Mailing Address - Phone:719-637-4466
Mailing Address - Fax:
Practice Address - Street 1:1010 THREE SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-8296
Practice Address - Country:US
Practice Address - Phone:970-764-2286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO425472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34524061Medicaid
AZ868721Medicaid
CO841155936001OtherROCKY MOUNTAIN HEALTH
CO34906525Medicaid
UTT0219Medicaid
NM34524061Medicaid
UTT0219Medicaid
CO841155936001OtherROCKY MOUNTAIN HEALTH