MEDICARE: DR. W ROBERT BRINTON 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	2085R0202X	Diagnostic Radiology Physician	155062-1205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00207057	OTHER	UT	RR MEDICARE
5	P00651519	OTHER	UT	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275530289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. W ROBERT BRINTON M.D.

Provider Business Mailing Address
First Line	:	5444 S. GREEN ST.
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84123-5632
Country	:	US
Telephone Number	:	801-262-8120
Fax Number	:	801-262-3897

Provider Business Practice Location Address
First Line	:	5444 S. GREEN ST.
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84123-5632
Country	:	US
Telephone Number	:	801-262-8120
Fax Number	:	801-262-3897

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	06/07/2017

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Directions to “ DR. W ROBERT BRINTON M.D.” Practice Location

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