Healthcare Provider Details

I. General information

NPI: 1740920131
Provider Name (Legal Business Name): BRYAN STEWART HOLTZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 N MEDICAL DR
SALT LAKE CITY UT
84112-1100
US

IV. Provider business mailing address

85 N MEDICAL DR
SALT LAKE CITY UT
84112-1100
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-5458
  • Fax:
Mailing address:
  • Phone: 801-587-5458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number14279445-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number14279445-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: