MEDICARE: KRAIG DYE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	14253380-1206	UT

General Provider Information

NPI Number	:	1821846494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRAIG DYE

Provider Business Mailing Address
First Line	:	10433 S REDWOOD RD STE 2
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-8502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10433 S REDWOOD RD STE 2
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-8502
Country	:	US
Telephone Number	:	801-260-1919
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	03/09/2026

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