Healthcare Provider Details

I. General information

NPI: 1417074865
Provider Name (Legal Business Name): ELIZABETH A GRAUL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 S 700 E STE 14
SALT LAKE CITY UT
84107-2585
US

IV. Provider business mailing address

3970 S 700 E STE 14
SALT LAKE CITY UT
84107-2585
US

V. Phone/Fax

Practice location:
  • Phone: 385-257-6284
  • Fax: 801-281-9681
Mailing address:
  • Phone: 385-257-6284
  • Fax: 801-281-9681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2751391-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: