Provider Demographics
NPI:1053397752
Name:BRINTON, GREGORY SHERMAN (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:SHERMAN
Last Name:BRINTON
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 1:5169 COTTONWOOD ST STE 630
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6771
Mailing Address - Country:US
Mailing Address - Phone:801-281-3030
Mailing Address - Fax:801-281-3033
Practice Address - Street 1:5169 COTTONWOOD ST STE 630
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-6771
Practice Address - Country:US
Practice Address - Phone:801-281-3030
Practice Address - Fax:801-281-3033
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1693191205207W00000X
UT169319-1205207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
870525682OtherTAX ID #
WY108068700Medicaid
ID003029400Medicaid
180002878OtherRAILROAD MEDICARE
WY108068700Medicaid
870525682OtherTAX ID #
005545101Medicare ID - Type Unspecified
C63548Medicare UPIN
180002878OtherRAILROAD MEDICARE
000002811Medicare ID - Type Unspecified