Provider Demographics
NPI:1760621940
Name:HEMARD, BRYAN PAUL SR (BRYAN HEMARD, MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:PAUL
Last Name:HEMARD
Suffix:SR
Gender:M
Credentials:BRYAN HEMARD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 CANYON COVE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6336
Mailing Address - Country:US
Mailing Address - Phone:801-278-9150
Mailing Address - Fax:801-278-9152
Practice Address - Street 1:6308 CANYON COVE DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6336
Practice Address - Country:US
Practice Address - Phone:801-278-9150
Practice Address - Fax:801-278-9152
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.011222207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B63968Medicare UPIN