Provider Demographics
NPI:1548406325
Name:JAMES, BRENT CARL (MD, MSTAT)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:CARL
Last Name:JAMES
Suffix:
Gender:M
Credentials:MD, MSTAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 S STATE ST FL 16
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1633
Mailing Address - Country:US
Mailing Address - Phone:801-442-3730
Mailing Address - Fax:
Practice Address - Street 1:36 S STATE ST FL 16
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1633
Practice Address - Country:US
Practice Address - Phone:801-442-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-27
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT164149-1205208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice