Provider Demographics
NPI:1891973152
Name:DRY CREEK FAMILY PRACTICE
Entity Type:Organization
Organization Name:DRY CREEK FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-766-4214
Mailing Address - Street 1:3300 N. RUNNING CREEK WAY
Mailing Address - Street 2:BUILDING B, SUITE 100
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043
Mailing Address - Country:US
Mailing Address - Phone:801-766-4214
Mailing Address - Fax:801-407-3052
Practice Address - Street 1:3300 N. RUNNING CREEK WAY
Practice Address - Street 2:BUILDING B, SUITE 100
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:801-766-4214
Practice Address - Fax:801-407-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3185351205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT029445370001Medicaid
UT264182OtherALTIUS
UT02944537007001OtherBLUE CROSS BLUE SHIELD
UT5838465OtherAETNA
UT5838465OtherAETNA