Healthcare Provider Details

I. General information

NPI: 1801384409
Provider Name (Legal Business Name): BRYAN WEED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2018
Last Update Date: 07/09/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 E 440 N STE A
VINEYARD UT
84059-8121
US

IV. Provider business mailing address

747 E 440 N STE A
OREM UT
84059-8121
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7883
  • Fax:
Mailing address:
  • Phone: 607-427-6173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12198837-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: