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Individual

CHARLES G PRIBBLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
100 N MEDICAL DR, SALT LAKE CITY, UT 84113-1103
(801) 993-9551
(801) 733-5872
Mailing address
100 N MEDICAL DR, SALT LAKE CITY, UT 84113-1103

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
173715-1205
UT
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
173715-1205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
002085560
FIRST HEALTH
UT
05
002967300
ID
05
105131800
WY
01
107006307101
IHC
UT
01
174281
DESERET MUTUAL
UT
01
2000040
UNITED HEALTHCARE
UT
01
29927
PEHP
UT
05
401765
MT
01
870280408PR2
EDUCATORS MUTUAL
UT
01
8920
HEALTHY U
UT
01
PR00809
MOLINA
UT
01
QM0000049539
ALTIUS
UT
Enumeration date
08/29/2006
Last updated
12/12/2024
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