Provider Demographics
NPI:1871680579
Name:BEHRMANN, GARY L (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:BEHRMANN
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 246
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-0246
Mailing Address - Country:US
Mailing Address - Phone:801-465-4877
Mailing Address - Fax:801-465-4879
Practice Address - Street 1:1172 E 100 N STE 2
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1668
Practice Address - Country:US
Practice Address - Phone:801-465-4877
Practice Address - Fax:801-465-4879
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT168086-12052080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC63508Medicare UPIN