Provider Demographics
NPI:1144264755
Name:BROWN, GARY R (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:BROWN
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 1:1830 BLAKE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4215
Mailing Address - Country:US
Mailing Address - Phone:970-945-0253
Mailing Address - Fax:
Practice Address - Street 1:1830 BLAKE AVE STE 102
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4215
Practice Address - Country:US
Practice Address - Phone:970-945-0253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0039722208D00000X, 204D00000X
CA19172208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36873861Medicaid
COCOAAA3762Medicare PIN
CO36873861Medicaid
810007Medicare PIN