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NPI Code Detail

MEDICARE: BRADLEY PRESTWICH MD

MEDICARE: BRADLEY PRESTWICH 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
1207Q00000XFamily Medicine Physician9498500-1205UT

General Provider Information

NPI Number : 1215357942
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY PRESTWICH MD
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12473 S MINUTEMAN DR
Second Line :
City : DRAPER
State : UT
Zip : 84020-7870
Country : US
Telephone Number : 801-495-7900
Fax Number : 801-495-7990
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2014
Last Update Date : 07/15/2024

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Directions to “ BRADLEY PRESTWICH MD” Practice Location

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