Healthcare Provider Details

I. General information

NPI: 1457337594
Provider Name (Legal Business Name): STEVEN H. WARNOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11762 SOUTH STATE ST SUITE 220
DRAPER UT
84020-4000
US

IV. Provider business mailing address

11762 SOUTH STATE ST SUITE 220
DRAPER UT
84020-4000
US

V. Phone/Fax

Practice location:
  • Phone: 801-571-2020
  • Fax: 801-571-6899
Mailing address:
  • Phone: 801-571-2020
  • Fax: 801-571-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number263363-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: