Healthcare Provider Details

I. General information

NPI: 1255332656
Provider Name (Legal Business Name): DONALD JOHN BRUST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ROUND VALLEY DR STE 200
PARK CITY UT
84060-7552
US

IV. Provider business mailing address

PO BOX 27128
SLC UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-658-7400
  • Fax:
Mailing address:
  • Phone: 435-658-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number13072454-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: