Provider Demographics
NPI:1336109891
Name:CREAGER, DICK (MD)
Entity Type:Individual
Prefix:
First Name:DICK
Middle Name:
Last Name:CREAGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S 500 E
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3460 PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2049
Practice Address - Country:US
Practice Address - Phone:801-964-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT170837-1205207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD0766Medicaid
UT005567138Medicare ID - Type Unspecified1600 ANTELOPE DR, LAYTON
UT005568349Medicare ID - Type Unspecified3460 PIONEER PKWY, WVC
UT005567233Medicare ID - Type Unspecified5475 S 500 E, OGDEN
UT005568549Medicare ID - Type Unspecified630 MEDICAL DR, BOUNTIFUL
UTE37671Medicare UPIN
UT005568442Medicare ID - Type Unspecified3580 W 9000 S, W JORDAN
UT005786127Medicare ID - Type Unspecified2055 N MAIN, TOOELE
UTD0766Medicaid