Healthcare Provider Details

I. General information

NPI: 1215253182
Provider Name (Legal Business Name): GRETCHEN MAE OAKLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR SUITE 3C120
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

50 N MEDICAL DR SUITE 3C120
SALT LAKE CITY UT
84132-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7514
  • Fax: 801-585-5744
Mailing address:
  • Phone: 801-581-7514
  • Fax: 801-585-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number8134461-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: