Provider Demographics
NPI:1356420574
Name:BRZOWSKI, ANITA E (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:E
Last Name:BRZOWSKI
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 1:1769 WASATCH DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1401
Mailing Address - Country:US
Mailing Address - Phone:801-479-8270
Mailing Address - Fax:
Practice Address - Street 1:4403 HARRISON BLVD STE 4600
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3293
Practice Address - Country:US
Practice Address - Phone:801-387-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3773171205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics