Provider Demographics
NPI:1306943121
Name:DUPONT, GREGORY PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PATRICK
Last Name:DUPONT
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 1:9103 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:801-432-8690
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:801-432-8690
Practice Address - Fax:801-432-8681
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT180866-1205174400000X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057893Medicare ID - Type Unspecified
UTB22404Medicare UPIN