Individual
GEOFFREY MATTHEW CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 ROUND VALLEY DR, PARK CITY, UT 84060-7552
(435) 658-7000
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
(435) 658-7000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5848509-1205
UT
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
5848509-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D6280
—
UT
Enumeration date
03/30/2006
Last updated
07/13/2023
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