Provider Demographics
NPI:1598031858
Name:FLAMMER, BRANDON MARK (DO)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:MARK
Last Name:FLAMMER
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 1:144 SOUTH 500 EAST, SECOND FLOOR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1907
Mailing Address - Country:US
Mailing Address - Phone:801-463-7415
Mailing Address - Fax:801-463-7341
Practice Address - Street 1:144 S 500 E FL 2
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1907
Practice Address - Country:US
Practice Address - Phone:801-463-7415
Practice Address - Fax:801-463-7341
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11942207P00000X
UT8935532-1204207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine