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General NPI Number Information
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NPI Number | 1073993283
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Entity Type | Individual
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Provider Name | COLTEN DIRK BRACKEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 571 EAST MAIN STREET
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City | ENTERPRISE
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State | UT
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Zip | 84725
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Country | US
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Telephone | 435-878-5711
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Fax | 435-878-5712
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Provider Business Mailing Address
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Address Line | 1055 N 500 W
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City | PROVO
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State | UT
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Zip | 84604-3305
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Country | US
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Telephone | 801-354-8225
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Fax | 801-377-5757
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9832788-1205
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License Number State | UT
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