Provider Demographics
NPI:1548695729
Name:GALE, DERRICK CRIPPS (MD)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:CRIPPS
Last Name:GALE
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 1:756 E 12200 S
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9724
Mailing Address - Country:US
Mailing Address - Phone:801-328-2522
Mailing Address - Fax:
Practice Address - Street 1:4063 W 12600 S
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7302
Practice Address - Country:US
Practice Address - Phone:801-328-2522
Practice Address - Fax:801-533-0589
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6005207Y00000X
MO2013019934207Y00000X
UT11131583-1205207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology