Provider Demographics
NPI:1003246950
Name:BRIGHAM INTERNAL MEDICINE
Entity Type:Organization
Organization Name:BRIGHAM INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARKESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-538-1733
Mailing Address - Street 1:1050 SOUTH MEDICAL DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302
Mailing Address - Country:US
Mailing Address - Phone:435-538-1733
Mailing Address - Fax:435-538-1752
Practice Address - Street 1:1050 SOUTH MEDICAL DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302
Practice Address - Country:US
Practice Address - Phone:435-538-1733
Practice Address - Fax:435-538-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000002378Medicare Oscar/Certification