Basic Information
| Provider Information | |||||||||
| NPI: | 1225129158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 WESTBROOK CIR | ||||||||
| Address2: | |||||||||
| City: | KAYSVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840371586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015893177 | ||||||||
| FaxNumber: | 8014759499 | ||||||||
| Practice Location | |||||||||
| Address1: | 2132 N 1700 W STE 230 | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840417060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017733900 | ||||||||
| FaxNumber: | 8017733900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 207XX0005X | 187506-1205 | UT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.