Provider Demographics
NPI:1063522589
Name:MCALLISTER, BRADLEY J (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST #800
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:8TH AVENUE AND C STREET
Practice Address - Street 2:LDS HOSPITAL
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT185405-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001563700Medicaid
UT107005855101OtherIHC
AZ820648Medicaid
UT37804OtherPEHP
UT53254OtherHEALTHY U
UTQM0000075886OtherALTIUS
UT8597445OtherWORKERS COMP
UT870545614MC1OtherEDUCATORS MUTUAL
UTPRA01569OtherMOLINA
WY002083525Medicaid
UT2090168OtherUNITED HEALTHCARE
UT1502954OtherUMWA
UT870545614MC1OtherEDUCATORS MUTUAL
UT107005855101OtherIHC
UT1502954OtherUMWA
UT2090168OtherUNITED HEALTHCARE