Brian Willoughby M.D. P.C.

Primary specialty

Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X

License

DR.0040115 Issued in CO

Legal business name

BRIAN WILLOUGHBY M.D. P.C.

Practice address

255 Detroit St
Denver, CO 80206-4833

Phone

(303) 320-5700

Fax

(303) 322-6129

NPI assigned

Aug 21, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brian Willoughby, M.D.NPI 1962425710

Title

Owner

Phone

(303) 320-5700

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brian J Willoughby, M.D.

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Denver, CO
  • NPI 1962425710
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463356800000",
    "number": "1841483120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 DETROIT ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802064833",
            "telephone_number": "303-320-5700",
            "fax_number": "303-322-6129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 DETROIT ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802064833",
            "telephone_number": "303-320-5700",
            "fax_number": "303-322-6129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN WILLOUGHBY M.D. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-21",
        "last_updated": "2016-05-16",
        "status": "A",
        "authorized_official_last_name": "WILLOUGHBY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-320-5700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CO",
            "license": "40115",
            "primary": false
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "CO",
            "license": "DR.0040115",
            "primary": true
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "CO",
            "license": "40115",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "463768",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "28836235",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kelly Brick, ATC
• Derrick Brickert

• Ophthalmic Plastic and Reconstructive Surgery Physician in Denver, CO
• Providers in Denver, CO by specialty
• Ophthalmic Plastic and Reconstructive Surgery Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.