Provider Demographics
NPI:1154577856
Name:MCCARTHY, BREAN DREW (DO)
Entity type:Individual
Prefix:DR
First Name:BREAN
Middle Name:DREW
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:BUDDY
Other - Middle Name:DREW
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4613
Mailing Address - Country:US
Mailing Address - Phone:719-526-7440
Mailing Address - Fax:
Practice Address - Street 1:221 5TH ST S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2422
Practice Address - Country:US
Practice Address - Phone:406-228-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011728207XX0005X
KS05-39569207XX0005X
CODR0052455207XX0005X
MT87187207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1154577856Medicaid
CO10429867Medicaid