Provider Demographics
NPI:1760593313
Name:BRANDT, WILLIAM F (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:BRANDT
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:PO BOX 160534
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84016-0534
Mailing Address - Country:US
Mailing Address - Phone:801-479-0312
Mailing Address - Fax:801-479-3364
Practice Address - Street 1:1916 LAYTON HILLS PKWY 250
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5723
Practice Address - Country:US
Practice Address - Phone:801-479-0312
Practice Address - Fax:801-479-3364
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1722341205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD20478Medicare UPIN
UT005711504Medicare ID - Type Unspecified