MEDICARE: DICK CREAGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	170837-1205	UT
2	207P00000X	Emergency Medicine Physician	170837-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336109891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DICK CREAGER MD

Provider Business Mailing Address
First Line	:	144 S 500 E
Second Line	:	2ND FLOOR
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3460 PIONEER PKWY
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2049
Country	:	US
Telephone Number	:	801-964-3100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	04/22/2010

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