Basic Information
| Provider Information | |||||||||
| NPI: | 1134322555 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEBHARDT | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2521 BROADWAY ST | ||||||||
| Address2: | #201 | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803044238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034430476 | ||||||||
| FaxNumber: | 8778043532 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 BALSAM AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803043404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034402273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 02/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD-14320 | HI | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | DR-49518 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.