Provider Demographics
NPI:1356766034
Name:BRACKEN, LAMAR (DVM)
Entity type:Individual
Prefix:DR
First Name:LAMAR
Middle Name:
Last Name:BRACKEN
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3373
Mailing Address - Country:US
Mailing Address - Phone:435-628-1634
Mailing Address - Fax:
Practice Address - Street 1:55 S BLUFF ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3373
Practice Address - Country:US
Practice Address - Phone:435-628-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT118182-2801174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian