MEDICARE: DR. BRIAN GARY DRAGE M.D.

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	348406-1205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000065216	OTHER	UT	MEDICARE PTAN

General Provider Information

NPI Number	:	1932278785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN GARY DRAGE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4460 SO HIGHLAND DR
Second Line	:	#400
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124
Country	:	US
Telephone Number	:	801-272-4111
Fax Number	:	801-272-5989

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	02/10/2026

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