Healthcare Provider Details

I. General information

NPI: 1043283856
Provider Name (Legal Business Name): STANTON MILLER SMITH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 E 5900 S # 102
MURRAY UT
84107-7287
US

IV. Provider business mailing address

168 E 5900 S # 102
MURRAY UT
84107-7287
US

V. Phone/Fax

Practice location:
  • Phone: 801-441-2719
  • Fax: 801-327-2304
Mailing address:
  • Phone: 801-441-2719
  • Fax: 801-327-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number1045170501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: