Basic Information
| Provider Information | |||||||||
| NPI: | 1669441036 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGEE | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 559 VINCENT ST | ||||||||
| Address2: | ATTN: 21 AMDS/SGPF - FLIGHT MED | ||||||||
| City: | PETERSON AFB | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809141540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195262273 | ||||||||
| FaxNumber: | 8778131756 | ||||||||
| Practice Location | |||||||||
| Address1: | 559 VINCENT ST | ||||||||
| Address2: | ATTN: 21 AMDS/SGPF - FLIGHT MED | ||||||||
| City: | PETERSON AFB | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809141540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195262273 | ||||||||
| FaxNumber: | 8778131756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 04/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | N | Other Service Providers | Military Health Care Provider | 2083A0100X | 34324 | CO | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine |
No ID Information.