Healthcare Provider Details

I. General information

NPI: 1528217841
Provider Name (Legal Business Name): CHRISTOPHER N BERRETT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13073 N PROSPECTOR WAY
ALPINE UT
84004-2041
US

IV. Provider business mailing address

13073 N PROSPECTOR WAY
ALPINE UT
84004-2041
US

V. Phone/Fax

Practice location:
  • Phone: 801-633-9194
  • Fax:
Mailing address:
  • Phone: 801-633-9194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A24388
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02003955A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5485087-1204
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number21355
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: