Healthcare Provider Details

I. General information

NPI: 1912351297
Provider Name (Legal Business Name): BRENDEN JAY GALLAGHER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 S 900 E
MURRAY UT
84117-7209
US

IV. Provider business mailing address

PO BOX 3299
CARSON CITY NV
89702-3299
US

V. Phone/Fax

Practice location:
  • Phone: 801-447-1485
  • Fax:
Mailing address:
  • Phone: 775-222-0042
  • Fax: 775-431-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number11238744-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: