Provider Demographics
NPI:1013437029
Name:DEIBERT, BRENT JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JAMES
Last Name:DEIBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4745 ARAPAHOE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1082
Mailing Address - Country:US
Mailing Address - Phone:303-444-3000
Mailing Address - Fax:303-444-3226
Practice Address - Street 1:4745 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1080
Practice Address - Country:US
Practice Address - Phone:303-444-3000
Practice Address - Fax:303-444-3226
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-01255207W00000X
CODR.0070550207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology