Healthcare Provider Details

I. General information

NPI: 1962323022
Provider Name (Legal Business Name): MTGRAHAM HEALTH ENTERPRISES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 E SIESTA DR
SANDY UT
84093-6145
US

IV. Provider business mailing address

1281 E SIESTA DR
SANDY UT
84093-6145
US

V. Phone/Fax

Practice location:
  • Phone: 801-707-2645
  • Fax:
Mailing address:
  • Phone: 801-707-2645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY EUGENE GRAHAM
Title or Position: OWNER
Credential: MD
Phone: 801-707-2645