Healthcare Provider Details

I. General information

NPI: 1689872897
Provider Name (Legal Business Name): GRANITE PEAKS GI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1393 E SEGO LILY DR
SANDY UT
84092-4350
US

IV. Provider business mailing address

1393 E SEGO LILY DR
SANDY UT
84092-4350
US

V. Phone/Fax

Practice location:
  • Phone: 801-619-9000
  • Fax: 801-619-9001
Mailing address:
  • Phone: 801-619-9000
  • Fax: 801-619-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2901281205
License Number StateUT

VIII. Authorized Official

Name: DR. CHRISTOPHER S CUTLER
Title or Position: PHYSICIAN
Credential: MD
Phone: 801-619-9000