Provider Demographics
NPI:1689683823
Name:CHILD, BRENT S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:S
Last Name:CHILD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST #800
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:8TH AVENUE AND C STREET
Practice Address - Street 2:LDS HOSPITAL
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT79-163630-1205207L00000X
UT163630-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ288177Medicaid
UT8597445OtherWORKERS COMP FUND
UT870545614CH2OtherEDUCATORS MUTUAL
NV002082843Medicaid
UT107005371101OtherIHC
UT2090168OtherUNITED HEALTHCARE
UT37777OtherPEHP
UTQM0000075886OtherALTIUS
ID003619600Medicaid
UT3252OtherHEALTHY U
WY110169200Medicaid
UT1502954OtherUMWA
UT36621OtherDESERET MUTUAL
UTPRA05761OtherMOLINA
NV002082843Medicaid
UT2090168OtherUNITED HEALTHCARE
AZ288177Medicaid