NPI 1164517009 · live from the CMS NPI Registry
Mark B. Bromberg, M.D.,Ph.D.
Psychiatry & Neurology, Neurology in Salt Lake City, UT. National Provider Identifier 1164517009, active.
NPI record
| NPI | 1164517009 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychiatry & Neurology, Neurology 2084N0400X |
| Practice location | 30 N 1900 E Som # 3r210, Salt Lake City, UT 84132 |
| Practice phone | 801-585-5885 |
| Mailing address | 2782 St Marys Way, Salt Lake City, UT 84108 |
| Enumerated | October 4, 2006 |
| Last updated | November 11, 2021 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatry & Neurology, Neurology | 2084N0400X | 8340A (WY) |
| Psychiatry & Neurology, Neurology primary | 2084N0400X | 274745-1205 (UT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.