Healthcare Provider Details

I. General information

NPI: 1619554201
Provider Name (Legal Business Name): DALTON K. BRADY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 E 3900 S STE 200
SALT LAKE CITY UT
84124-1550
US

IV. Provider business mailing address

1521 E 3900 S STE 200
SALT LAKE CITY UT
84124-1550
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-8486
  • Fax: 801-587-8699
Mailing address:
  • Phone: 801-262-8486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number7491686-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number7491686-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number7491686-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number7491686-1205
License Number StateUT
# 5
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number7491686-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: