Provider Demographics
NPI:1689893174
Name:DRAPER FAMILY MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DRAPER FAMILY MEDICAL ASSOCIATES, LLC
Other - Org Name:DRAPER FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:801-523-1300
Mailing Address - Street 1:12272 SOUTH 800 EAST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020
Mailing Address - Country:US
Mailing Address - Phone:801-523-1300
Mailing Address - Fax:801-523-1301
Practice Address - Street 1:12272 SOUTH 800 EAST
Practice Address - Street 2:SUITE A
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020
Practice Address - Country:US
Practice Address - Phone:801-523-1300
Practice Address - Fax:801-523-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5668757-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000060997Medicare PIN