Healthcare Provider Details

I. General information

NPI: 1497936033
Provider Name (Legal Business Name): BRETTON NEWMAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 BRYAN AVE
SALT LAKE CITY UT
84105-2802
US

IV. Provider business mailing address

PO BOX 27688
SALT LAKE CITY UT
84127-0688
US

V. Phone/Fax

Practice location:
  • Phone: 801-910-0382
  • Fax:
Mailing address:
  • Phone: 801-534-1360
  • Fax: 801-366-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRETTON NEWMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 801-910-0382