Provider Demographics
NPI:1902087885
Name:DR BRIAN RICHMAN PC
Entity Type:Organization
Organization Name:DR BRIAN RICHMAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-825-4709
Mailing Address - Street 1:1660 W ANTELOPE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1155
Mailing Address - Country:US
Mailing Address - Phone:801-825-4703
Mailing Address - Fax:801-774-0735
Practice Address - Street 1:1660 W ANTELOPE DR STE 110
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1155
Practice Address - Country:US
Practice Address - Phone:801-825-4703
Practice Address - Fax:801-774-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106650-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT234764OtherDESERET MUTUAL
UT522988353001OtherBLUECROSS BLUE SHIELD
UT522988354001OtherBLUECROSS BLUESHIELD
UT107007424101OtherSELECT HEALTH
UT0000200881OtherALTIUS
UT0000200882OtherALTIUS
UT522988353021Medicaid
UT0000200882OtherALTIUS
UT522988354001OtherBLUECROSS BLUESHIELD
UT234764OtherDESERET MUTUAL