Provider Demographics
NPI:1285929430
Name:ESPLIN, BRANDT L (MD)
Entity type:Individual
Prefix:
First Name:BRANDT
Middle Name:L
Last Name:ESPLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W ATTN: CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:1055 N 500 W STE 202, BLDG C
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-8460
Practice Address - Country:US
Practice Address - Phone:801-374-2367
Practice Address - Fax:801-374-2367
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10204311-1205207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP01167837OtherRAILROAD MEDICARE
IAENROLLEDMedicaid
MNENROLLEDMedicaid
MN110015545Medicare PIN