Provider Demographics
NPI:1568774727
Name:CRAVEN, PHILIP WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:WILLIAM
Last Name:CRAVEN
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 1:434 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1720
Mailing Address - Country:US
Mailing Address - Phone:347-633-4575
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:SUITE: 1C026
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0002
Practice Address - Country:US
Practice Address - Phone:801-581-2730
Practice Address - Fax:801-585-0603
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8137269-1205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine