Organization Name: | BRETT J EARL MD PC |
NPI Number: | 1972992352 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRETT EEARL (OWNER) |
Mailing Address: | 1576 S 500 W Suite 101 Woods Cross |
State: | UT US |
Postal Code: | 840107433 |
Phone Number: | 8013037329 |
Fax Number: | 8013037329 |
NPI Enumeration Date: | 01/22/2015 |
NPI Last Update Date: | 01/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |