Provider Demographics
NPI:1982872701
Name:CURTIS, GLADE BRIAN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:GLADE
Middle Name:BRIAN
Last Name:CURTIS
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6337 HIGHLAND DRIVE
Mailing Address - Street 2:#2054
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2107
Mailing Address - Country:US
Mailing Address - Phone:801-664-5322
Mailing Address - Fax:801-572-8144
Practice Address - Street 1:6337 HIGHLAND DR
Practice Address - Street 2:#2054
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2107
Practice Address - Country:US
Practice Address - Phone:801-664-5322
Practice Address - Fax:801-664-5322
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT169515-1205101Y00000X, 207V00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology