PREMIER PLASTIC SURGERY GROUP OF UTAH (NPI# 1689906976) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689906976 |
| Entity Type | Organization |
| Organization Name | PREMIER PLASTIC SURGERY GROUP OF UTAH |
| Practice Address |
11762 S State St Ste 220 Draper UT 84020-7156 |
| Practice Telephone | 8015712020 |
| Practice Fax Number | 8015716899 |
| Mailing Telephone | 8015712020 |
| Mailing Fax Number | 8015716899 |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2011-01-19 |
| Authorized Official Name | STEPHANIE WHITE (SECRETARY) |
| Authorized Official Telephone | 8015712020 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | 528276851028 | 05 | |
| UT | 529316986001 | 05 |
| Street Address |
11762 S STATE ST STE 220 |
| City | DRAPER |
| State | UT |
| Zip Code | 84020-7156 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760572366 | Richard H Fryer | Plastic Surgery | 11762 S State St Ste 220, Draper, UT 84020-7156 | 2006-10-13 |
| 1659666295 | Nicholas Kay Howland | Plastic Surgery | 11762 S State St Ste 220, Draper, UT 84020-7156 | 2011-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194322776 | Chase Larsen Dmd Pllc | Dentist | 723 E 12200 S, Draper, UT 84020 | 2020-10-06 |
| 1780222380 | Derek Cragun | Counselor | 11706 700 E, Draper, UT 84020 | 2019-12-13 |
| 1720629371 | Own My Health Medical | Clinic/Center | 12371 900 E, Suite 102, Draper, UT 84020 | 2019-10-04 |
| 1508418856 | Thomas Mifflin | Physician Assistant | 721 East 12200 South, Draper, UT 84020 | 2019-07-16 |
| 1124670872 | Necia Dalley | Registered Nurse | 11800 S State St, Draper, UT 84020 | 2019-07-12 |
| 1285100784 | Tracey M Williams | Psychologist | 13200 S 1601 E, Draper, UT 84020 | 2018-10-23 |
| 1275008328 | Amoni Paeahelotu Finau | Community Health Worker | 13703 Wheatfield Way, Draper, UT 84020 | 2018-10-04 |
| 1891275525 | Cynthia Mae Bolton | Psychologist | 1192 E Draper Parkway # 447, Draper, UT 84020 | 2018-08-21 |
| 1164908026 | Headin' Home Inc. | Community/Behavioral Health | 12300 S. 150 W., Draper, UT 84020 | 2018-07-13 |
| 1366932576 | Forest Hulet | Dentist | 219 E 12300, Ste I-5, Draper, UT 84020 | 2018-05-14 |
| Find all providers in zip 84020 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720005317 | Jason T Koo | Surgery | 13249 Cascade Glen Dr, Draper, UT 84020-7146 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720122583 | Christopher P Kelly | Surgery | 11464 S Parkway Plaza Dr Ste 300, South Jordan, UT 84095-6053 | 2007-02-16 |
| 1437216306 | Kimball M Crofts | Surgery | 385 W 600 N, Lindon, UT 84042-1330 | 2007-01-02 |
| 1508878372 | Jayant Prasad Agarwal | Surgery | Division of Plastic Surgery Administrative Office, 30 North 1900 East 3b205, Salt Lake City, UT 84132-0001 | 2006-08-12 |
| 1295705697 | Todd B Engen | Surgery | 1735 N State St, Provo, UT 84604-1010 | 2006-01-26 |
| 1538151063 | Allisyn Okawa | Surgery | 4700 Harrison Blvd, Ogden, UT 84403-4303 | 2005-08-19 |
| 1346633203 | University of Utah Dental Services | Surgery | 50 N Medical Dr, Salt Lake City, UT 84132-0100 | 2015-03-16 |
| 1275937088 | University of Utah Adult Services | Surgery | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2014-10-22 |
| 1538572169 | Vincent Surgical Arts, LLC | Surgery | 6710 S Blackstone Rd, Suite 201, Cottonwood Heights, UT 84121-6072 | 2014-06-11 |
| 1073729943 | Lauren Opal Florence | Surgery | 1250 East 3900 South, Suite #301, Salt Lake City, UT 84124-1362 | 2007-05-15 |
| 1851506786 | Seth A Riddle, M.d. P.C. | Surgery | 1055 N 300 W Ste 401, Provo, UT 84604-3306 | 2007-05-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.