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NPI Code Detail

MEDICARE: EASTON BRADY ROTHWELL DO

MEDICARE: EASTON BRADY ROTHWELL DO
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
1208M00000XHospitalist Physician14280206-1204UT

General Provider Information

NPI Number : 1083316087
Entity Type Code : Individual
Provider Name (Legal Business Name) : EASTON BRADY ROTHWELL DO
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1301 PENNSYLVANIA AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2122
Country : US
Telephone Number : 817-250-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2023
Last Update Date : 05/14/2026

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Directions to “ EASTON BRADY ROTHWELL DO” Practice Location

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