Active NPI
William R Graden, MD
- General Practice Physician
- Provo, UT
National Provider Identifier
1174707046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 4806596-1205
- Practice address
- 1750 N Wymount Terrace Dr
Provo, UT 84602-4405 - Phone
- (801) 422-2771
- Fax
- (801) 422-0761
- NPI assigned
- Dec 27, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 4806596-1205 | UT | Primary |
Addresses
Primary practice location
1750 N Wymount Terrace Dr
Provo, UT 84602-4405
Mailing address
1750 N Wymount Terrace Dr
Provo, UT 84602-4405
Phone (801) 422-2771
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4806596-1205 | UT | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201478400000",
"number": "1174707046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1750 N WYMOUNT TERRACE DR",
"city": "PROVO",
"state": "UT",
"postal_code": "846024405",
"telephone_number": "801-422-2771",
"fax_number": "801-422-0761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1750 N WYMOUNT TERRACE DR",
"city": "PROVO",
"state": "UT",
"postal_code": "846024405",
"telephone_number": "801-422-2771",
"fax_number": "801-422-0761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRADEN",
"first_name": "WILLIAM",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-27",
"last_updated": "2008-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "UT",
"license": "4806596-1205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.