Individual
BRIAN KEITH WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6053 S QUEBEC ST STE 203, CENTENNIAL, CO 80111-4505
(720) 708-4287
(720) 815-2581
Mailing address
6053 S QUEBEC ST STE 203, CENTENNIAL, CO 80111-4505
(720) 708-4287
(720) 815-2581
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
41287
CO
2084P0804X
Child & Adolescent Psychiatry Physician
41287
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043211683
NPI NUMBER
CO
05
—
70583072
—
CO
01
—
C802299
MEDICARE
CO
01
—
C811544
MEDICARE PTAN
CO
Enumeration date
08/04/2005
Last updated
10/04/2024
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