Provider Demographics
NPI:1073875647
Name:BLEAZARD, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:BLEAZARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 W SAINT GEORGE BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-1308
Mailing Address - Country:US
Mailing Address - Phone:435-668-6000
Mailing Address - Fax:
Practice Address - Street 1:216 W SAINT GEORGE BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-1308
Practice Address - Country:US
Practice Address - Phone:435-668-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator