Healthcare Provider Details

I. General information

NPI: 1306805577
Provider Name (Legal Business Name): BRIAN S. KRACHMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 HOMESTEAD RD STE 100
PARK CITY UT
84098-4882
US

IV. Provider business mailing address

2720 HOMESTEAD RD STE 100
PARK CITY UT
84098-4882
US

V. Phone/Fax

Practice location:
  • Phone: 435-940-9400
  • Fax: 435-940-9405
Mailing address:
  • Phone: 678-904-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13934643-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: