Healthcare Provider Details

I. General information

NPI: 1760821326
Provider Name (Legal Business Name): JEFF L STOKER D.V.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 N WASHINGTON BLVD
NORTH OGDEN UT
84404-3210
US

IV. Provider business mailing address

1580 N WASHINGTON BLVD
NORTH OGDEN UT
84404-3210
US

V. Phone/Fax

Practice location:
  • Phone: 801-782-4401
  • Fax: 801-782-9864
Mailing address:
  • Phone: 801-782-4401
  • Fax: 801-782-9864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number273898-2801
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: