Healthcare Provider Details

I. General information

NPI: 1598952145
Provider Name (Legal Business Name): CHRISTOPHER CANALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 EAST MEDICAL DRIVE SUITE 205
BOUNTIFUL UT
84010-4916
US

IV. Provider business mailing address

6360 S 3000 E #220
SALT LAKE CITY UT
84121-6923
US

V. Phone/Fax

Practice location:
  • Phone: 801-298-0057
  • Fax: 801-298-9765
Mailing address:
  • Phone: 801-944-3199
  • Fax: 801-944-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number5210819-8905
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number5210819-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1598952145
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: