Individual
DR. DEVAN GRINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11762 S STATE ST STE 110, DRAPER, UT 84020-7158
(385) 218-0587
(385) 381-4447
Mailing address
11762 S STATE ST STE 110, DRAPER, UT 84020-7158
(385) 218-0587
(385) 381-4447
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
374716-1205
UT
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
374716-1205
UT
2086S0122X
Plastic and Reconstructive Surgery Physician
374716-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103I933353
MEDICARE PTAN
—
Enumeration date
05/24/2007
Last updated
03/19/2025
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