Healthcare Provider Details

I. General information

NPI: 1386000974
Provider Name (Legal Business Name): BRIAN GREATHOUSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 10/06/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HELIX BUILDING 5050 30 NORTH MARIO CAPECCHI DRIVE
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

HELIX BUILDING 5050 30 NORTH MARIO CAPECCHI DRIVE
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6393
  • Fax:
Mailing address:
  • Phone: 801-581-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14253852-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: