Basic Information
| Provider Information | |||||||||
| NPI: | 1700262524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRICKLEY | ||||||||
| FirstName: | ROBERT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 571117 | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841571117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015079700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5121 S COTTONWOOD ST | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841075701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015079700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2015 | ||||||||
| LastUpdateDate: | 07/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 12196A | WY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 11262080-1205 | UT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.