Healthcare Provider Details

I. General information

NPI: 1114595097
Provider Name (Legal Business Name): ZACHARY JEROME CULP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MARIO CAPECHHI DR RM 5N234
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

30 N MARIO CAPECHHI DR RM 5N234
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 801-581-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number14211590-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBP10076987
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: