Healthcare Provider Details

I. General information

NPI: 1831401728
Provider Name (Legal Business Name): GREGORY SMITH PEIRCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 N UNIVERSITY AVE STE 250
PROVO UT
84604-6695
US

IV. Provider business mailing address

3550 N UNIVERSITY AVE STE 250
PROVO UT
84604-6695
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-9625
  • Fax: 801-374-9690
Mailing address:
  • Phone: 801-367-6008
  • Fax: 801-374-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number63566
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number13828790-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: