NPI 1609397207 · live from the CMS NPI Registry
Braden Russ Brklacich, DPM
Podiatrist, Foot & Ankle Surgery in Riverton, UT. National Provider Identifier 1609397207, active.
NPI record
| NPI | 1609397207 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Podiatrist, Foot & Ankle Surgery 213ES0103X |
| Practice location | 12523 S Creek Meadow Rd Ste 105, Riverton, UT 84065 |
| Practice phone | 801-253-6886 |
| Mailing address | 1583 E Greenley Hill Dr, Eagle Mountain, UT 84005 |
| Enumerated | July 5, 2017 |
| Last updated | February 22, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Podiatrist, Foot & Ankle Surgery primary | 213ES0103X | 10861469-0501 (UT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.