MEDICARE: BRETTON HEATHER NEWMAN 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	207Q00000X	Family Medicine Physician	4796206-1205	UT
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	4796206-1205	UT

General Provider Information

NPI Number	:	1508861477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETTON HEATHER NEWMAN M.D.

Provider Business Mailing Address
First Line	:	1552 E BRYAN AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2802
Country	:	US
Telephone Number	:	801-483-2923
Fax Number	:	801-483-3086

Provider Business Practice Location Address
First Line	:	1552 BRYAN AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2802
Country	:	US
Telephone Number	:	801-483-2923
Fax Number	:	801-483-3086

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	12/15/2015

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