Provider Demographics
NPI:1235158304
Name:BRENTEN C PUGH, MD
Entity Type:Organization
Organization Name:BRENTEN C PUGH, MD
Other - Org Name:JORDAN LANDING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENTEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-280-7774
Mailing Address - Street 1:3895 W 7800 S STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5616
Mailing Address - Country:US
Mailing Address - Phone:801-280-7774
Mailing Address - Fax:801-280-7774
Practice Address - Street 1:3895 W 7800 S STE 100
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5616
Practice Address - Country:US
Practice Address - Phone:801-280-7774
Practice Address - Fax:801-280-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty