Provider Demographics
NPI:1912989518
Name:BRODSTEIN, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:BRODSTEIN
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 1:874 COUNTRY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2208
Mailing Address - Country:US
Mailing Address - Phone:801-399-1149
Mailing Address - Fax:801-394-4481
Practice Address - Street 1:874 COUNTRY HILLS DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2208
Practice Address - Country:US
Practice Address - Phone:801-399-1149
Practice Address - Fax:801-394-4481
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1866961205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0515900001Medicare NSC
UTF16952Medicare UPIN