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Organization

EBRAINMD, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRENT LEE CLYDE M.D. (OWNER)
(801) 295-2438
Entity
Organization

Contact information

Practice address
3401 S HIGHWAY 89, BOUNTIFUL, UT 84010-8517
(801) 295-2438
(800) 558-1912
Mailing address
3401 S HIGHWAY 89, BOUNTIFUL, UT 84010-8517
(801) 295-2438
(800) 558-1912

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
6555A
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
117443600
WY
Enumeration date
03/10/2008
Last updated
04/14/2016
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