Individual
DR. GERALD J GLEICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-1100
(801) 581-2955
Mailing address
PO BOX 3208, SALT LAKE CITY, UT 84110-3208
(801) 587-6340
(801) 587-6346
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
49317201205
UT
207KA0200X
Allergy Physician
49317201205
UT
207N00000X
Dermatology Physician
4931720-1205
UT
207R00000X
Internal Medicine Physician
Primary
4931720-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806805000
—
ID
05
—
870468377001
—
UT
05
—
J0854
—
NM
Enumeration date
07/24/2006
Last updated
11/01/2021
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