Provider Demographics
NPI:1306063425
Name:GREGORY P. DUPONT MD
Entity type:Organization
Organization Name:GREGORY P. DUPONT MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUPONT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-938-9703
Mailing Address - Street 1:9103 S 1300 W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-6706
Mailing Address - Country:US
Mailing Address - Phone:801-938-9703
Mailing Address - Fax:801-432-8681
Practice Address - Street 1:9103 S 1300 W
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6706
Practice Address - Country:US
Practice Address - Phone:801-938-9703
Practice Address - Fax:801-432-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty