Provider Demographics
NPI:1306807300
Name:EMERY, GARRETT (MD)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:EMERY
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 1:370 E SOUTH TEMPLE
Mailing Address - Street 2:STE 260
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 W ANTELOPE DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1120
Practice Address - Country:US
Practice Address - Phone:801-801-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12730207P00000X, 207PE0004X
UT358687-1205207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD2362Medicaid
UT005568424Medicare ID - Type Unspecified3580 W 9000 S, W JORDAN
UT005567209Medicare ID - Type Unspecified5475 W 500 E, OGDEN
UT005568533Medicare ID - Type Unspecified630 MEDICAL DR, BOUNTIFUL
NVAV233ZMedicare PIN
UT005568333Medicare ID - Type Unspecified3460 PIONEER PKWY, WVC
UTG70320Medicare UPIN
UT005568625Medicare ID - Type Unspecified1050 E SOUTH TEMPLE, SLC
UT005567109Medicare ID - Type Unspecified1600 ANTELOPE DR, LAYTON