MEDICARE: BRANDT L ESPLIN 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	207RH0003X	Hematology & Oncology Physician	10204311-1205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01167837	OTHER	MN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285929430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDT L ESPLIN MD

Provider Business Mailing Address
First Line	:	1055 N 500 W ATTN: CREDENTIALING
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604
Country	:	US
Telephone Number	:	801-354-8225
Fax Number	:	801-418-0941

Provider Business Practice Location Address
First Line	:	1055 N 500 W STE 202, BLDG C
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-8460
Country	:	US
Telephone Number	:	801-374-2367
Fax Number	:	801-374-2367

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

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	11/27/2023

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Directions to “ BRANDT L ESPLIN MD” Practice Location

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