Healthcare Provider Details

I. General information

NPI: 1851383350
Provider Name (Legal Business Name): BRENT A FELIX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
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

280 S MAIN ST
BOUNTIFUL UT
84010-6236
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-8486
  • Fax: 801-284-8699
Mailing address:
  • Phone: 801-503-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number341318-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: