Crockett, Geoffrey Matthew
Crockett, Geoffrey Matthew is an individual health care provider with primary practice located at 900 Round Valley Dr , Park City UT 84060-7552. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medical Services, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Crockett, Geoffrey Matthew can be contacted via phone (435) 658-7000.Contact Information
Primary practice address
900 Round Valley Dr
Park City UT 84060-7552
Phone: (435) 658-7000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medical Services | 207PE0004X | 5848509-1205 | Utah |
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 5848509-1205 | Utah |
Profile Details
| NPI number | 1780645697 |
|---|---|
| LBN Legal business name | Crockett, Geoffrey Matthew |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 30th, 2006 |
| Last updated | Jul 13th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780645697 | NPPES |
| Utah | MEDICAID | D6280 |
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