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General NPI Number Information
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NPI Number | 1649761586
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Entity Type | Individual
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Provider Name | GRAYSON DART DO
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Gender | Male
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Dates
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Enumeration Date | 05/26/2018
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 1031 S BLUFF ST STE 217
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City | ST GEORGE
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State | UT
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Zip | 84770-5206
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Country | US
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Telephone | 801-589-8917
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Fax |
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Provider Business Mailing Address
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Address Line | 466 E 4160 S
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City | WASHINGTON
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State | UT
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Zip | 84780-1572
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Country | US
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Telephone | 801-589-8917
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11839394-1204
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License Number State | UT
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