Individual
BRANDON M UTTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1950 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3129
(303) 306-7783
(303) 306-7753
Mailing address
PO BOX 1175, ENGLEWOOD, CO 80150-1175
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2831
CO
363AS0400X
Surgical Physician Assistant
2831
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71681531
—
CO
01
—
P00842822
RAILROAD MEDICARE PIN
CO
Enumeration date
01/22/2010
Last updated
02/26/2014
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