Provider Demographics
NPI:1699875807
Name:BRETHOUWER, NORMAN ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:ROBERT
Last Name:BRETHOUWER
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 1:1020 S TOWNSEND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4937
Mailing Address - Country:US
Mailing Address - Phone:970-249-3466
Mailing Address - Fax:970-249-3468
Practice Address - Street 1:1020 S TOWNSEND AVE STE A
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4937
Practice Address - Country:US
Practice Address - Phone:970-249-3466
Practice Address - Fax:970-249-3468
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15237204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01152370Medicaid
COC2042Medicare ID - Type Unspecified
COD22816Medicare UPIN