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NPI Code Detail

MEDICARE: BRENT J ALLEN MD

MEDICARE: BRENT J ALLEN 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
1208600000XSurgery Physician49302681204UT

General Provider Information

NPI Number : 1477660389
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENT J ALLEN MD
Provider Business Mailing Address
First Line : PO BOX 30180
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84130-0180
Country : US
Telephone Number : 801-357-7475
Fax Number : 801-357-7997
Provider Business Practice Location Address
First Line : 1000 N MAIN ST
Second Line :
City : RICHFIELD
State : UT
Zip : 84701-1857
Country : US
Telephone Number : 435-893-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2006
Last Update Date : 01/30/2014

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Directions to “ BRENT J ALLEN MD” Practice Location

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