Basic Information
| Provider Information | |||||||||
| NPI: | 1043574221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUNSON | ||||||||
| FirstName: | COLT | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1181 HARVEST RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846535639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017353088 | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 W 800 N | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840573660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017146000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2012 | ||||||||
| LastUpdateDate: | 12/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 10259876-1204 | UT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.