Healthcare Provider Details

I. General information

NPI: 1417463217
Provider Name (Legal Business Name): CINDY J. BROUGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2017
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 W 930 N
PLEASANT GROVE UT
84062-4104
US

IV. Provider business mailing address

81 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

V. Phone/Fax

Practice location:
  • Phone: 801-492-1999
  • Fax:
Mailing address:
  • Phone: 801-581-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11149899-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: