Provider Demographics
NPI:1790878460
Name:MURDOCK, BRENT JOHN (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:JOHN
Last Name:MURDOCK
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 1:1034 NORTH 500 WEST
Practice Address - Street 2:UTAH VALLEY REGIONAL MEDICAL CENTER
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5537276-1204207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2090168OtherUNITED HEALTHCARE
UT1502954OtherUMWA
UT832675OtherDESERET MUTUAL
UT870545614MUROtherEDUCATORS MUTUAL
UTQM0000075886OtherALTIUS
UT107024915101OtherIHC
NV100502496Medicaid
UT93345OtherHEALTHY U
UTTPRA08913OtherMOLINA
UT55372761200001OtherBCBS
ID806791200Medicaid
WY119193400Medicaid
AZ840745Medicaid
UT77305OtherPEHP
ID806791200Medicaid
WY119193400Medicaid
UT870545614MUROtherEDUCATORS MUTUAL