Healthcare Provider Details

I. General information

NPI: 1578553210
Provider Name (Legal Business Name): GARY NEIL STOKES M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 EAST 1300 NORTH
LOGAN UT
84341
US

IV. Provider business mailing address

655 EAST 1300 NORTH
LOGAN UT
84341
US

V. Phone/Fax

Practice location:
  • Phone: 435-792-6500
  • Fax: 435-792-6608
Mailing address:
  • Phone: 435-792-6500
  • Fax: 435-792-6608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number10119882-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0119882-8905
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: