Individual
BRIAN P TUDOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 N 500 W, SUITE 202, PROVO, UT 84604-3305
(801) 354-8225
(801) 429-8150
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(801) 354-8225
(801) 429-8150
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
1658161205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107006264101
IHC
UT
01
—
110019670
PALMETTO
UT
01
—
14055
PEHP
UT
01
—
30-00029
UNITED HEALTHCARE
UT
05
—
870281028000
—
UT
01
—
870281028TU1
EMIA
UT
01
—
QM0000009167
ALTIUS
UT
Enumeration date
09/02/2006
Last updated
10/01/2021
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