Healthcare Provider Details

I. General information

NPI: 1871680579
Provider Name (Legal Business Name): GARY L. BEHRMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1172 E 100 N STE 2
PAYSON UT
84651-1668
US

IV. Provider business mailing address

PO BOX 246
PAYSON UT
84651-0246
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-4877
  • Fax: 801-465-4879
Mailing address:
  • Phone: 801-465-4877
  • Fax: 801-465-4879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number168086-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: