Basic Information
| Provider Information | |||||||||
| NPI: | 1114153384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINDAU | ||||||||
| FirstName: | BRETT | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 743 HORIZON CT STE 100 | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815068715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702417600 | ||||||||
| FaxNumber: | 9702459094 | ||||||||
| Practice Location | |||||||||
| Address1: | 743 HORIZON CT STE 100 | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815068715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702417600 | ||||||||
| FaxNumber: | 9702459094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2009 | ||||||||
| LastUpdateDate: | 04/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DR.0049425 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.