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NPI Code Detail

MEDICARE: DR. GARY MILLS STEPHENSON M.D.

MEDICARE: DR. GARY MILLS STEPHENSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician1545091205UT

General Provider Information

NPI Number : 1306084033
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY MILLS STEPHENSON M.D.
Provider Business Mailing Address
First Line : 150 S 300 E
Second Line : # 207
City : SALT LAKE CITY
State : UT
Zip : 84111-2013
Country : US
Telephone Number : 801-521-3055
Fax Number :
Provider Business Practice Location Address
First Line : 150 S 300 E
Second Line : # 207
City : SALT LAKE CITY
State : UT
Zip : 84111-2013
Country : US
Telephone Number : 801-521-3055
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2009
Last Update Date : 02/03/2009

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