Individual
GREGORY G PATCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1433 N 1075 W STE 104, FARMINGTON, UT 84025-2746
(801) 299-2200
(801) 296-6199
Mailing address
PO BOX 25488, SALT LAKE CITY, UT 84125-0488
(800) 475-3698
(801) 296-6199
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
180827-1205
UT
2085R0202X
Diagnostic Radiology Physician
Primary
180827-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107007749104
SELECTHEALTH
UT
01
—
266077
DESERET MUTUAL BENEFITS ADMINISTRATORS
UT
01
—
300064158
RAILROAD MEDICARE
UT
05
—
D0957
—
UT
Enumeration date
11/08/2005
Last updated
02/26/2019
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