Provider Demographics
NPI:1588766299
Name:ENCE, BRADFORD KELLY (MD)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:KELLY
Last Name:ENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:39 PROFESSIONAL WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1675
Practice Address - Country:US
Practice Address - Phone:801-465-4805
Practice Address - Fax:801-465-4354
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN72827207Y00000X
UT1779331205207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT233117OtherALTIUS
UT169404OtherDMBA
UT870281028BKEOtherEMIA
UT10-00159OtherUNITED HEALTHCARE
UT107006732105OtherIHC
UT81446OtherPEHP
UTP00207619OtherPALMETTO
UT870281028000Medicaid
UT005502561Medicare PIN
UT81446OtherPEHP
UTF15314Medicare UPIN