Healthcare Provider Details

I. General information

NPI: 1568552164
Provider Name (Legal Business Name): PATRICK E. GREIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S WAKARA WAY
SALT LAKE CITY UT
84108-1200
US

IV. Provider business mailing address

PO BOX 413067
SALT LAKE CITY UT
84141-3067
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-7109
  • Fax:
Mailing address:
  • Phone: 801-213-3900
  • Fax: 801-585-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number332294-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number332294-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: