Healthcare Provider Details

I. General information

NPI: 1386825024
Provider Name (Legal Business Name): CRAIG ALAN COLEBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2007
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12391 S 4000 W SUITE 100
RIVERTON UT
84096-7012
US

IV. Provider business mailing address

2965 W 3500 S STE 100
WEST VALLEY CITY UT
84119-3602
US

V. Phone/Fax

Practice location:
  • Phone: 801-302-1700
  • Fax:
Mailing address:
  • Phone: 801-965-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7637496-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number7637496-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7637496-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: