Provider Demographics
NPI:1598952145
Name:CANALE, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:CANALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6360 S 3000 E
Mailing Address - Street 2:#220
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6923
Mailing Address - Country:US
Mailing Address - Phone:801-944-3199
Mailing Address - Fax:801-944-3180
Practice Address - Street 1:620 EAST MEDICAL DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4916
Practice Address - Country:US
Practice Address - Phone:801-298-0057
Practice Address - Fax:801-298-9765
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5210819-8905207RG0100X
UT5210819-1205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1598952145Medicaid
UT1598952145Medicaid