| Organization Name: | EBRAINMD, LLC |
| NPI Number: | 1811167547 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRENT LEE CLYDE (OWNER) |
| Mailing Address: | 3401 S Highway 89 Bountiful |
| State: | UT US |
| Postal Code: | 840108517 |
| Phone Number: | 8012952438 |
| Fax Number: | 8005581912 |
| NPI Enumeration Date: | 03/10/2008 |
| NPI Last Update Date: | 04/14/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 6555A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |