Provider Demographics
NPI:1598152852
Name:ROBINSON, BRENTON (MD)
Entity type:Individual
Prefix:
First Name:BRENTON
Middle Name:
Last Name:ROBINSON
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 1:5292 S COLLEGE DR STE 302
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2991
Mailing Address - Country:US
Mailing Address - Phone:801-293-8100
Mailing Address - Fax:
Practice Address - Street 1:5292 S COLLEGE DR STE 302
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2991
Practice Address - Country:US
Practice Address - Phone:801-293-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13342531-1205208200000X
IL036146373208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery