Healthcare Provider Details

I. General information

NPI: 1417995911
Provider Name (Legal Business Name): WENDY A BREYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 S COTTONWOOD ST STE 610
MURRAY UT
84107-5704
US

IV. Provider business mailing address

5171 S COTTONWOOD ST
MURRAY UT
84107-5704
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-3630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD60891954
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number48342921205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: