Healthcare Provider Details

I. General information

NPI: 1770631194
Provider Name (Legal Business Name): MOUNTAIN WEST EAR NOSE AND THROAT LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 RENAISSANCE TOWNE DR SUITE 310
BOUNTIFUL UT
84010-7667
US

IV. Provider business mailing address

2255 N 1700 W SUITE 200
LAYTON UT
84041-1140
US

V. Phone/Fax

Practice location:
  • Phone: 801-295-5581
  • Fax: 801-295-9253
Mailing address:
  • Phone: 801-776-2180
  • Fax: 801-776-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number178486-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number188579-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5395A
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5387A
License Number StateWY
# 5
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number182660-1205
License Number StateUT
# 6
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number264339-1205
License Number StateUT

VIII. Authorized Official

Name: DR. CURT R STOCK
Title or Position: GEN.
Credential: M.D.
Phone: 801-295-5581