Provider Demographics
NPI:1932210853
Name:MCCOMAS, GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:MCCOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:5121 S COTTONWOOD STREET
Practice Address - Street 2:INTERMOUNTAIN MEDICAL CENTER
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84157
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT92-186754-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107005813101OtherIHC
UT8597445OtherWORKERS COMP
UT1997OtherHEALTHY U
ID805588800Medicaid
UT45547OtherPEHP
UT870545614MC3OtherEDUCATORS MUTUAL
NV10501269Medicaid
UT2090168OtherUNITED HEALTHCARE
UT311880OtherDESERET MUTUAL
UTPRA02485OtherMOLINA
AZ822272Medicaid
UTQM0000075886OtherALTIUS
WY114057400Medicaid
WY114057400Medicaid
UTF29213Medicare UPIN
AZ822272Medicaid