Individual
BRIAN D WICKHAM
Active
Individual
BRIAN D WICKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M D
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
45123
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45123
COLORADO STATE LICENSE
CO
05
—
86706802
—
CO
Enumeration date
05/03/2007
Last updated
09/25/2007
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