Healthcare Provider Details

I. General information

NPI: 1053808501
Provider Name (Legal Business Name): KHALID HARARAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 04/15/2024
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 E VINE ST STE 16
MURRAY UT
84107-5541
US

IV. Provider business mailing address

688 E VINE ST STE 16
MURRAY UT
84107-5541
US

V. Phone/Fax

Practice location:
  • Phone: 801-509-9138
  • Fax: 801-797-0237
Mailing address:
  • Phone: 801-509-9138
  • Fax: 801-797-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number311812
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD211549
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number12424228-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number12424228-1205
License Number StateUT
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12424228-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: