MEDICARE: PATRICIA BEARNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	173454-1205	UT

General Provider Information

NPI Number	:	1013920677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA BEARNSON M.D.

Provider Business Mailing Address
First Line	:	4465 S 900 E STE 275
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2469
Country	:	US
Telephone Number	:	801-272-6100
Fax Number	:	801-272-6101

Provider Business Practice Location Address
First Line	:	4465 S 900 E STE 275
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2469
Country	:	US
Telephone Number	:	801-272-6100
Fax Number	:	801-272-6101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	03/12/2012

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