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General NPI Number Information
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NPI Number | 1841271095
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Entity Type | Individual
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Provider Name | BRANDT RYAN GIBSON D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 358 N 1100 E STE 1
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City | AMERICAN FORK
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State | UT
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Zip | 84003-3250
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Country | US
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Telephone | 801-756-0765
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Fax | 81-756-1405
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Provider Business Mailing Address
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Address Line | 358 N 1100 E STE 1
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City | AMERICAN FORK
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State | UT
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Zip | 84003-3250
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Country | US
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Telephone | 801-756-0765
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Fax | 81-756-1405
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5093909-0501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 5093909-0501
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | 5093909-0501
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5093909-0501
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License Number State | UT
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