Healthcare Provider Details

I. General information

NPI: 1720384068
Provider Name (Legal Business Name): BRETT MOYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 S MAIN ST STE 4
BRIGHAM CITY UT
84302-3389
US

IV. Provider business mailing address

862 S. MAIN STREET SUITE#4
BRIGHAM CITY UT
84302
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-1799
  • Fax:
Mailing address:
  • Phone: 435-723-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: