Individual
DR. BRANDT RYAN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
358 N 1100 E STE 1, AMERICAN FORK, UT 84003-3250
(801) 756-0765
(081) 756-1405
Mailing address
358 N 1100 E STE 1, AMERICAN FORK, UT 84003-3250
(801) 756-0765
(081) 756-1405
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
5093909-0501
UT
213EP1101X
Primary Podiatric Medicine Podiatrist
5093909-0501
UT
213ES0000X
Sports Medicine Podiatrist
5093909-0501
UT
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5093909-0501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107028407101
IHC PIN
UT
01
—
243399
ALTIUS PIN
UT
01
—
27-00195
UNITED HEALTH CARE PIN
UT
01
—
50939090500001
BCBS PIN
UT
01
—
79031
PEHP PIN
UT
01
—
882626
DMBA PIN
UT
Enumeration date
11/07/2005
Last updated
12/08/2021
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