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NPI Code Detail

MEDICARE: DONALD JOHN BRUST MD

MEDICARE: DONALD JOHN BRUST 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
1207RG0100XGastroenterology Physician13072454-1205UT

General Provider Information

NPI Number : 1255332656
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD JOHN BRUST MD
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SLC
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 435-658-7400
Fax Number :
Provider Business Practice Location Address
First Line : 900 ROUND VALLEY DR STE 200
Second Line :
City : PARK CITY
State : UT
Zip : 84060-7552
Country : US
Telephone Number : 435-658-7400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 03/01/2023

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