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Contact Information

CRAIG A PACKHAM, PA-C
2356 N 400 E
STE 102
TOOELE, UT84074
 Phone: 435-833-9180
 Fax: 435-833-9177
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for CRAIG A PACKHAM · (Male)

NPI # 1104920354
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 09/09/2006
Last updated 07/15/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • UT License # 51058218002
  • UT Medicaid D4703
Hospital affiliation(s)
  • MOUNTAIN WEST MEDICAL CENTER - (Acute Care)
    2055 NORTH MAIN STREET
    TOOELE, UT 84074
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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