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MR. RICKY WILLIAM BRETTHAUER

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1164575072

Individual Registrant:
MR. RICKY WILLIAM BRETTHAUER 
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1853 OCONNELL BLVD BLDG 1042 FT CARSON, CO 80913-4055 US
Tel: 719-524-4670  Fax: --

Contact information for business:
5510 WHISKEY RIVER DR  COLORADO SPRINGS, CO 80922-4110 US
Tel: 719-550-9196  Fax: --

Registration Information:
NPI: 1164575072
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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