Individual
NOLAN R. BROOKSBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
151 W 200 N, VERNAL, UT 84078-1907
(435) 789-3342
Mailing address
150 W 100 N, VERNAL, UT 84078-2036
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5611703-1204
UT
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
55611703-1204
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56117031200001
BC/BS
UT
05
—
D5681
—
UT
01
—
P00187532
RAILROAD MEDICARE
UT
Enumeration date
06/10/2006
Last updated
04/15/2010
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