Provider Demographics
NPI:1255691986
Name:CONDIE, GREGORY LYMAN (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LYMAN
Last Name:CONDIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 W 4800 S
Mailing Address - Street 2:STE 101
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3781
Mailing Address - Country:US
Mailing Address - Phone:801-224-8800
Mailing Address - Fax:801-262-0998
Practice Address - Street 1:84 W 4800 S
Practice Address - Street 2:STE 101
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3781
Practice Address - Country:US
Practice Address - Phone:801-261-4988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10418147-1204208VP0014X
VA01022037692081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine