Healthcare Provider Details

I. General information

NPI: 1902148133
Provider Name (Legal Business Name): GREGORY A BAIRD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W SOUTH JORDAN PKWY STE 450
SOUTH JORDAN UT
84095-3946
US

IV. Provider business mailing address

PO BOX 550
RIVERTON UT
84065-0550
US

V. Phone/Fax

Practice location:
  • Phone: 801-919-3008
  • Fax: 801-960-1780
Mailing address:
  • Phone: 801-919-3008
  • Fax: 801-960-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number9148024-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9148024-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: