Provider Demographics
NPI:1912186289
Name:PHASE II ST GEORGE INC
Entity Type:Organization
Organization Name:PHASE II ST GEORGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-502-9024
Mailing Address - Street 1:230 N 1680 E
Mailing Address - Street 2:BLDG I
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2579
Mailing Address - Country:US
Mailing Address - Phone:435-627-2978
Mailing Address - Fax:
Practice Address - Street 1:230 N 1680 E
Practice Address - Street 2:BLDG I
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2579
Practice Address - Country:US
Practice Address - Phone:435-627-2978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2751391205207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000058012OtherMEDICARE GROUP ID NUMBER
F79887Medicare UPIN