MEDICARE: JOHN F BERMEN JR. 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	207X00000X	Orthopaedic Surgery Physician	1597111205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19010400	OTHER		OWCP

General Provider Information

NPI Number	:	1548351364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN F BERMEN JR. MD

Provider Business Mailing Address
First Line	:	3465 S PIONEER PARKWAY
Second Line	:	SUITE 5
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84129-2013
Country	:	US
Telephone Number	:	801-967-0282
Fax Number	:	801-967-0565

Provider Business Practice Location Address
First Line	:	3465 S 4155 WEST
Second Line	:	SUITE 5
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84120-2013
Country	:	US
Telephone Number	:	801-967-0282
Fax Number	:	801-967-0565

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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