Provider Demographics
NPI:1649761586
Name:DART, GRAYSON (DO)
Entity Type:Individual
Prefix:
First Name:GRAYSON
Middle Name:
Last Name:DART
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 1:466 E 4160 S
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-1572
Mailing Address - Country:US
Mailing Address - Phone:801-589-8917
Mailing Address - Fax:
Practice Address - Street 1:1031 S BLUFF ST STE 217
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5206
Practice Address - Country:US
Practice Address - Phone:801-589-8917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-26
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11839394-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine