Individual provider Active NPI

Gregg Michael Guilfoyle, DO

  • Plastic Surgery Physician
  • Draper, UT
National Provider Identifier
1972769917
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
11847500-1204 Issued in UT
Practice address
11762 S State St Ste 320
Draper, UT 84020-7166
Phone
(801) 702-9191
Fax
(877) 326-3388
NPI assigned
Jul 30, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 118475001204 UT
Plastic Surgery Physician 208200000X 11847500-1204 UT Primary
Surgery Physician 208600000X OS014237 PA

Addresses

Primary practice location

11762 S State St Ste 320
Draper, UT 84020-7166

Mailing address

11762 S State St Ste 320
Draper, UT 84020-7166
Phone (801) 702-9191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201001001673 UT Practitioner - Plastic and Reconstructive Surgery 5496926883 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
118475001204UTMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Peak Plastic Surgery, PLLC Plastic Surgery CurrentSince Nov 1, 2020 Accepting new patients
Precision Prosthetics LLC Current Accepting new patients

Locations

11762 S State St
Ste 315
Draper, UT 84020

96 E Kimballs Ln
Ste 304
Draper, UT 84020
Phone (801) 571-9433

11762 S State St
Ste 320
Draper, UT 84020
Phone (801) 380-3894

1055 N 300 W
Ste 301
Provo, UT 84604
Phone (385) 377-3833

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1972769917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11762 S STATE ST STE 320",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207166",
            "telephone_number": "801-702-9191",
            "fax_number": "877-326-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11762 S STATE ST STE 320",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207166",
            "telephone_number": "801-702-9191",
            "fax_number": "877-326-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUILFOYLE",
        "first_name": "GREGG",
        "middle_name": "MICHAEL",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-30",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "UT",
            "license": "118475001204",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "UT",
            "license": "11847500-1204",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "OS014237",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Draper, UT

Sources for this page

Verify at the official NPI Registry.