Provider Demographics
NPI:1285153346
Name:GILLESPIE, BRENT DOUGLASS (MSPAS)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:DOUGLASS
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:MSPAS
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Mailing Address - Street 1:7801 ACADEMY RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3379
Mailing Address - Country:US
Mailing Address - Phone:505-272-2700
Mailing Address - Fax:505-272-2760
Practice Address - Street 1:7801 ACADEMY RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3379
Practice Address - Country:US
Practice Address - Phone:505-272-2700
Practice Address - Fax:505-272-2760
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMPA2017-0067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant