Healthcare Provider Details

I. General information

NPI: 1861501694
Provider Name (Legal Business Name): JASON M STINNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 W ANTELOPE DR SUITE 125
LAYTON UT
84041-1139
US

IV. Provider business mailing address

1121 E 3900 S SUITE C-240
SALT LAKE CITY UT
84124-1214
US

V. Phone/Fax

Practice location:
  • Phone: 801-525-3022
  • Fax: 801-775-9508
Mailing address:
  • Phone: 801-262-9494
  • Fax: 801-266-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberM9050
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number379443-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: