MEDICARE: BRETTON NEWMAN MD LLC

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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1497936033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRETTON NEWMAN MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 27688
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0688
Country	:	US
Telephone Number	:	801-534-1360
Fax Number	:	801-366-9883

Provider Business Practice Location Address
First Line	:	1552 BRYAN AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2802
Country	:	US
Telephone Number	:	801-910-0382
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRETTON NEWMAN
Credential	:	MD
Telephone Number	:	801-910-0382

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	11/28/2007

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