MEDICARE: SETH JONAH BRAZIER

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	213E00000X	Podiatrist	E5251	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	213ES0103X	Foot & Ankle Surgery Podiatrist	11866363-0501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11866363-0501	OTHER	UT	LICENSE

General Provider Information

NPI Number	:	1033554324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH JONAH BRAZIER

Provider Business Mailing Address
First Line	:	2561 S 1560 W STE B
Second Line	:
City	:	WOODS CROSS
State	:	UT
Zip	:	84087-2361
Country	:	US
Telephone Number	:	801-505-0821
Fax Number	:	801-505-0803

Provider Business Practice Location Address
First Line	:	1973 N STATE ST
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-1012
Country	:	US
Telephone Number	:	801-373-2499
Fax Number	:	801-373-5200

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

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	08/03/2021

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Directions to “ SETH JONAH BRAZIER ” Practice Location

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