Healthcare Provider Details

I. General information

NPI: 1629371307
Provider Name (Legal Business Name): K2 FOOT AND ANKLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2010
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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1045170501
License Number StateUT

VIII. Authorized Official

Name: DR. STANTON M SMITH
Title or Position: MEMBER/PHYSICIAN
Credential: DPM
Phone: 801-441-2719