| Doctor Name: | CRAIG AARON PACKHAM |
| NPI Number: | 1104920354 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 51058218002 |
| Business Practice Address: | 2356 N 400 E Ste 102 Tooele, UT - 84074 |
| Business Phone Number: | 4358339180 |
| Business Fax Number: | 4358339177 |
| Mailing Address: | 2356 N 400 E, Ste 102 TOOELE |
| State: | UT |
| Postal Code: | 84074 |
| Phone Number: | 4358339180 |
| Fax Number: | 4358339177 |
| NPI Enumeration Date: | 09/09/2006 |
| NPI Last Update Date: | 08/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 51058218002 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |