Healthcare Provider Details

I. General information

NPI: 1780895755
Provider Name (Legal Business Name): DEVAN GRINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11762 S STATE ST STE 110
DRAPER UT
84020-7158
US

IV. Provider business mailing address

11762 S STATE ST STE 110
DRAPER UT
84020-7158
US

V. Phone/Fax

Practice location:
  • Phone: 385-218-0587
  • Fax: 385-381-4447
Mailing address:
  • Phone: 385-218-0587
  • Fax: 385-381-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number374716-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number374716-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number374716-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: