Provider Demographics
NPI:1013920677
Name:BEARNSON, PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BEARNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 S 900 E STE 275
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2469
Mailing Address - Country:US
Mailing Address - Phone:801-272-6100
Mailing Address - Fax:801-272-6101
Practice Address - Street 1:4465 S 900 E STE 275
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2469
Practice Address - Country:US
Practice Address - Phone:801-272-6100
Practice Address - Fax:801-272-6101
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT173454-1205207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E27804Medicare UPIN
000011483Medicare ID - Type Unspecified