Healthcare Provider Details

I. General information

NPI: 1497954416
Provider Name (Legal Business Name): RAFE C CONNORS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 E 3900 S STE 3500
SALT LAKE CITY UT
84124-1264
US

IV. Provider business mailing address

2950 N CHURCH ST STE 301
LAYTON UT
84040-6590
US

V. Phone/Fax

Practice location:
  • Phone: 801-476-6900
  • Fax:
Mailing address:
  • Phone: 801-777-7771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5414427-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number5414427-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: