Healthcare Provider Details

I. General information

NPI: 1013920677
Provider Name (Legal Business Name): PATRICIA BEARNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 S 900 E STE 275
SALT LAKE CITY UT
84124-2469
US

IV. Provider business mailing address

4465 S 900 E STE 275
SALT LAKE CITY UT
84124-2469
US

V. Phone/Fax

Practice location:
  • Phone: 801-272-6100
  • Fax: 801-272-6101
Mailing address:
  • Phone: 801-272-6100
  • Fax: 801-272-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number173454-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: