Provider Demographics
NPI:1033209614
Name:BRINTON, ELIOT ASHBY (MD)
Entity Type:Individual
Prefix:
First Name:ELIOT
Middle Name:ASHBY
Last Name:BRINTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0268
Mailing Address - Country:US
Mailing Address - Phone:801-296-2113
Mailing Address - Fax:801-296-1715
Practice Address - Street 1:421 S WAKARA WAY STE 121
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1244
Practice Address - Country:US
Practice Address - Phone:801-583-8852
Practice Address - Fax:801-581-6862
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5353571-1205207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1033209614Medicaid
UTU000076001Medicare PIN