Individual
BRETT WAYNE MARTINDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4700 HARRISON BLVD, OGDEN, UT 84403-4303
(801) 475-3300
(801) 475-3301
Mailing address
PO BOX 5546, DENVER, CO 80217-5546
(801) 475-3300
(801) 475-3301
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
9093263-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164860573
—
UT
01
—
U000098254
MEDICARE PART B
UT
Enumeration date
06/07/2013
Last updated
06/16/2018
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