Individual
DR. BRENT D GRAUERHOLZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 16TH ST, GREELEY, CO 80631-5114
(970) 350-2454
(970) 350-2447
Mailing address
1900 16TH ST, GREELEY, CO 80631-5114
(970) 350-2454
(970) 350-2447
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38073
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77431049
—
CO
01
—
P00944738
MEDICARE RAILROAD CARRIER PTAN
CO
Enumeration date
01/02/2006
Last updated
01/03/2017
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