Provider Demographics
NPI:1508861477
Name:NEWMAN, BRETTON HEATHER (MD)
Entity Type:Individual
Prefix:
First Name:BRETTON
Middle Name:HEATHER
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 E BRYAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2802
Mailing Address - Country:US
Mailing Address - Phone:801-483-2923
Mailing Address - Fax:801-483-3086
Practice Address - Street 1:1552 BRYAN AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2802
Practice Address - Country:US
Practice Address - Phone:801-483-2923
Practice Address - Fax:801-483-3086
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4796206-1205207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH52969Medicare UPIN