Healthcare Provider Details

I. General information

NPI: 1568394500
Provider Name (Legal Business Name): TOBIAS MCCLEAVE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11925 S STATE ST
DRAPER UT
84020-7735
US

IV. Provider business mailing address

14382 S ABBEY BEND LN
HERRIMAN UT
84096-1859
US

V. Phone/Fax

Practice location:
  • Phone: 801-545-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number157290
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: