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NPI Code Detail

MEDICARE: BRADLEY GEAKE

MEDICARE: BRADLEY GEAKE
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
1163WA2000XAdministrator Registered Nurse8634873-3102UT

General Provider Information

NPI Number : 1841129368
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY GEAKE
Provider Business Mailing Address
First Line : 50 N MEDICAL DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84132-0001
Country : US
Telephone Number : 801-585-5957
Fax Number :
Provider Business Practice Location Address
First Line : 50 N MEDICAL DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84132-0001
Country : US
Telephone Number : 801-585-5957
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2026
Last Update Date : 05/19/2026

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Directions to “ BRADLEY GEAKE ” Practice Location

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