Healthcare Provider Details

I. General information

NPI: 1366805921
Provider Name (Legal Business Name): CRAIG BARTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 S 8400 W STE 110
MAGNA UT
84044-4907
US

IV. Provider business mailing address

3665 S 8400 W STE 110
MAGNA UT
84044-4907
US

V. Phone/Fax

Practice location:
  • Phone: 801-250-9638
  • Fax: 801-250-3204
Mailing address:
  • Phone: 801-250-9638
  • Fax: 801-250-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number11755355-1205
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: