Healthcare Provider Details

I. General information

NPI: 1346507456
Provider Name (Legal Business Name): EVAN ROBERT BROWNIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 S WOODROW ST STE 101
MURRAY UT
84107-5843
US

IV. Provider business mailing address

2146 BELCOURT AVE VMG BUSINESS OFFICE
NASHVILLE TN
37212-3504
US

V. Phone/Fax

Practice location:
  • Phone: 801-313-7500
  • Fax: 801-313-7549
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number11293832-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: