MEDICARE: DR. JOHN BRYANT ALDER M.D.

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	207W00000X	Ophthalmology Physician	290691-1205	UT

General Provider Information

NPI Number	:	1508829144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BRYANT ALDER M.D.

Provider Business Mailing Address
First Line	:	6412 S 900 E
Second Line	:	#101
City	:	MURRAY
State	:	UT
Zip	:	84121-6048
Country	:	US
Telephone Number	:	801-262-3344
Fax Number	:	801-262-4967

Provider Business Practice Location Address
First Line	:	6412 S 900 E
Second Line	:	101
City	:	MURRAY
State	:	UT
Zip	:	84121-6048
Country	:	US
Telephone Number	:	801-262-3344
Fax Number	:	801-262-4967

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	04/15/2016

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