Provider Demographics
NPI:1386942324
Name:PERRY, BRIAN W
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:PERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2895 S HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6921
Mailing Address - Country:US
Mailing Address - Phone:303-667-8415
Mailing Address - Fax:303-759-8415
Practice Address - Street 1:2895 S HUDSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6921
Practice Address - Country:US
Practice Address - Phone:303-667-8415
Practice Address - Fax:303-759-8415
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO116216163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse