MEDICARE: DR. WILLIAM BRADLEY POSS MD

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	2080P0203X	Pediatric Critical Care Medicine Physician	1105210220	UT

General Provider Information

NPI Number	:	1588634729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM BRADLEY POSS MD

Provider Business Mailing Address
First Line	:	PO BOX 581289
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84158-1289
Country	:	US
Telephone Number	:	801-587-7572
Fax Number	:	801-581-8686

Provider Business Practice Location Address
First Line	:	295 E CHIPETA WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1287
Country	:	US
Telephone Number	:	801-587-7575
Fax Number	:	801-581-8686

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	09/25/2015

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