Individual
BRIAN T WATERFALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9660 SOUTH 1300 EAST, ALTA VIEW HOSPITAL, SANDY, UT 84094
(801) 501-2600
(801) 733-5618
Mailing address
3340 NORTH CENTER ST, #800, LEHI, UT 84043-7406
(801) 990-1911
(801) 990-1912
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
179925-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003036800
—
ID
05
—
100501229
—
NV
01
—
107005771102
IHC
UT
05
—
118885200
—
WY
01
—
1502954
UMWA
UT
01
—
20086
DESERET MUTUAL
UT
01
—
2090168
UNITED HEALTHCARE
UT
01
—
73553
PEHP
UT
05
—
820664
—
AZ
01
—
870545614WA3
EDUCATORS MUTUAL
UT
01
—
9288
HEALTHY U
UT
01
—
PRA02103
MOLINA
UT
01
—
QM0000075886
ALTIUS
UT
Enumeration date
09/06/2006
Last updated
10/15/2012
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