Provider Demographics
NPI:1508829144
Name:ALDER, JOHN BRYANT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRYANT
Last Name:ALDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6412 S 900 E
Mailing Address - Street 2:#101
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6048
Mailing Address - Country:US
Mailing Address - Phone:801-262-3344
Mailing Address - Fax:801-262-4967
Practice Address - Street 1:6412 S 900 E
Practice Address - Street 2:101
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-6048
Practice Address - Country:US
Practice Address - Phone:801-262-3344
Practice Address - Fax:801-262-4967
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT290691-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG02663Medicare UPIN
000090515Medicare ID - Type Unspecified