Provider Demographics
NPI:1124077391
Name:CRANER, GREGORY E (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:CRANER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-429-8180
Practice Address - Street 1:1055 N 500 W
Practice Address - Street 2:SUITE 100 BLDG B
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3305
Practice Address - Country:US
Practice Address - Phone:801-374-1268
Practice Address - Fax:801-429-8041
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1808221205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT19417OtherPEHP
UT107007387101OtherIHC HEALTHPLANS
UT870281028CR1OtherEMIA
UT29-00037OtherUNITED HEALTHCARE
UTQM0000009179OtherALTIUS
UT870281028000Medicaid
UT5672OtherDMBA
UT19417OtherPEHP