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General NPI Number Information
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NPI Number | 1053396770
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Entity Type | Individual
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Provider Name | BRIAN CLINT HALES M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1600 W ANTELOPE DR
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City | LAYTON
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State | UT
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Zip | 84041-1120
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Country | US
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Telephone | 801-774-7140
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Fax |
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Provider Business Mailing Address
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Address Line | 204 N 2350 E
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City | LAYTON
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State | UT
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Zip | 84040-3101
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Country | US
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Telephone | 801-540-6792
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 180496-1205
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License Number State | UT
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