Healthcare Provider Details

I. General information

NPI: 1245263177
Provider Name (Legal Business Name): MATTHEW FRANK BRADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 N 400 E
PRICE UT
84501-2509
US

IV. Provider business mailing address

PO BOX 460
SUNNYSIDE UT
84539-0460
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-6338
  • Fax:
Mailing address:
  • Phone: 435-888-4411
  • Fax: 435-888-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7622501-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: