Provider Demographics
NPI:1467474676
Name:BRADY, BRUCE RYAN (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:RYAN
Last Name:BRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:B.
Other - Middle Name:RYAN
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 571800
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84157-1800
Mailing Address - Country:US
Mailing Address - Phone:801-747-2800
Mailing Address - Fax:801-747-3022
Practice Address - Street 1:470 EAST 3900 SOUTH
Practice Address - Street 2:#200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2332
Practice Address - Country:US
Practice Address - Phone:801-747-2800
Practice Address - Fax:801-747-3022
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4848635-1205207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
G79685Medicare UPIN
UT005545689Medicare PIN