Provider Demographics
NPI:1316019847
Name:JAMIE BRANT MD PLLC
Entity type:Organization
Organization Name:JAMIE BRANT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-479-8500
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-0176
Mailing Address - Country:US
Mailing Address - Phone:970-479-8500
Mailing Address - Fax:970-569-7735
Practice Address - Street 1:320 BEARD CREEK RD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-479-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO806614Medicare PIN
COI20078Medicare UPIN