Organization
MAIN STREET FAMILY MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLTEN DIRK BRACKEN MD (MD/OWNER)
(435) 878-5711
Entity
Organization
Contact information
Practice address
571 EAST MAIN STREET, ENTERPRISE, UT 84725
(435) 878-5711
Mailing address
571 EAST MAIN STREET, ENTERPRISE, UT 84725
(435) 878-5711
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/09/2021
Last updated
10/29/2021
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