Provider Demographics
NPI:1285857268
Name:PARSON, BROC B (DO)
Entity Type:Individual
Prefix:
First Name:BROC
Middle Name:B
Last Name:PARSON
Suffix:
Gender:M
Credentials:DO
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 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:435-865-3440
Mailing Address - Fax:435-865-3472
Practice Address - Street 1:962 SAGE DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-1885
Practice Address - Country:US
Practice Address - Phone:435-865-3440
Practice Address - Fax:435-865-3472
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11012864207Q00000X
UT7052055-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine