Healthcare Provider Details

I. General information

NPI: 1487277059
Provider Name (Legal Business Name): BRADY JAMES LAYTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 11/14/2020
Certification Date: 11/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 S 500 E
OGDEN UT
84405-6905
US

IV. Provider business mailing address

1254 E 2400 N
NORTH OGDEN UT
84414-2591
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-2111
  • Fax:
Mailing address:
  • Phone: 801-300-5021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7693879-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7693879-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: