Provider Demographics
NPI:1538471313
Name:BLASER, BRETT (DO)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:BLASER
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 1:3500 HARRISON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2038
Mailing Address - Country:US
Mailing Address - Phone:801-515-7997
Mailing Address - Fax:385-333-7413
Practice Address - Street 1:475 40TH ST STE 111
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1856
Practice Address - Country:US
Practice Address - Phone:801-515-7997
Practice Address - Fax:385-333-7413
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-44396207Q00000X
NVCL0039207Q00000X
IDOC-0029207Q00000X
WI50207Q00000X
AZR1817207Q00000X
ALDO.1932207Q00000X
MN66505207Q00000X
UT9267007-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR1817OtherTRAINING PERMIT