Individual
BRIAN R BRADSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 N 500 W, SUITE 111, PROVO, UT 84604-3305
(801) 374-8999
(801) 429-8063
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2806031205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03-00064
UNITED HEALTHCARE
UT
01
—
070008058
PALMETTO
UT
01
—
107006919101
IHC HEALTHPLANS
UT
01
—
225984
DMBA
UT
01
—
36578
PEHP
UT
01
—
QM0000001619
ALTIUS
UT
Enumeration date
05/02/2006
Last updated
11/27/2023
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