Basic Information
| Provider Information | |||||||||
| NPI: | 1992725964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DWINNELL | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1721 E 19TH AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038692160 | ||||||||
| FaxNumber: | 3038692544 | ||||||||
| Practice Location | |||||||||
| Address1: | 1721 E 19TH AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038692160 | ||||||||
| FaxNumber: | 3038692544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 06/22/2016 | ||||||||
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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 | 207R00000X | 32719 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 49280732 | 05 | CO | MEDICAID | 01327196 | 05 | CO | MEDICAID |