Provider Demographics
NPI:1164980181
Name:CREER, ADAM THOMAS
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:THOMAS
Last Name:CREER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 S MAIN ST STE 108
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-6000
Mailing Address - Country:US
Mailing Address - Phone:240-356-1000
Mailing Address - Fax:
Practice Address - Street 1:2880 S MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-6000
Practice Address - Country:US
Practice Address - Phone:240-356-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7417569-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily