MEDICARE: GLADE BRIAN CURTIS M.D., MPH

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	101Y00000X	Counselor	169515-1205	UT
2	207V00000X	Obstetrics & Gynecology Physician	169515-1205	UT
3	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	169515-1205	UT

General Provider Information

NPI Number	:	1982872701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLADE BRIAN CURTIS M.D., MPH

Provider Business Mailing Address
First Line	:	6337 HIGHLAND DRIVE
Second Line	:	#2054
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2107
Country	:	US
Telephone Number	:	801-664-5322
Fax Number	:	801-572-8144

Provider Business Practice Location Address
First Line	:	6337 HIGHLAND DR
Second Line	:	#2054
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2107
Country	:	US
Telephone Number	:	801-664-5322
Fax Number	:	801-664-5322

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

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	03/05/2020

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