Basic Information
Provider Information
NPI: 1053518670
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAISER
FirstName: BRIAN
MiddleName: LEE
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1106 E PROSPECT RD
Address2: SUITE 100
City: FORT COLLINS
State: CO
PostalCode: 805255304
CountryCode: US
TelephoneNumber: 9704824373
FaxNumber: 9704845682
Practice Location
Address1: 1106 E PROSPECT RD
Address2: SUITE 100
City: FORT COLLINS
State: CO
PostalCode: 805255304
CountryCode: US
TelephoneNumber: 9704824373
FaxNumber: 9704845682
Other Information
ProviderEnumerationDate: 06/28/2007
LastUpdateDate: 03/22/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XDR.0053671COY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

ID Information
IDTypeStateIssuerDescription
13836340005WY MEDICAID
3038955105CO MEDICAID
P0136305101COMEDICARE RAILROADOTHER


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