MEDICARE: DR. BRAD WRIGHT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	8172696-1205	UT
2	2085N0700X	Neuroradiology Physician	8172696-1205	UT

General Provider Information

NPI Number	:	1023317328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD WRIGHT MD

Provider Business Mailing Address
First Line	:	3321 S 3010 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-3170
Country	:	US
Telephone Number	:	802-310-2843
Fax Number	:

Provider Business Practice Location Address
First Line	:	3321 S 3010 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-3170
Country	:	US
Telephone Number	:	802-310-2843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	12/20/2021

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