Individual
BRENT FARR ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1321 E SOUTH TEMPLE, 5, SALT LAKE CITY, UT 84102-1830
(801) 643-5809
Mailing address
1321 E SOUTH TEMPLE, 5, SALT LAKE CITY, UT 84102-1830
(801) 643-5809
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
168260-1205
UT
Other
Enumeration date
02/14/2012
Last updated
02/14/2012
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