Provider Demographics
NPI:1134422538
Name:BAUGH, BREVAN B (ND)
Entity type:Individual
Prefix:DR
First Name:BREVAN
Middle Name:B
Last Name:BAUGH
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:565 W 465 N
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-4801
Mailing Address - Country:US
Mailing Address - Phone:435-213-3029
Mailing Address - Fax:435-213-9591
Practice Address - Street 1:565 W 465 N
Practice Address - Street 2:SUITE 150
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-4801
Practice Address - Country:US
Practice Address - Phone:435-213-3029
Practice Address - Fax:435-213-9591
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7730185-7100175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath