Healthcare Provider Details

I. General information

NPI: 1912960014
Provider Name (Legal Business Name): STEPHEN TALMAGE THOMSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6028 S RIDGELINE DR SUITE #102
OGDEN UT
84405-6914
US

IV. Provider business mailing address

6028 S RIDGELINE DR SUITE #102
OGDEN UT
84405-6914
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-3324
  • Fax: 801-394-2807
Mailing address:
  • Phone: 801-399-3324
  • Fax: 801-394-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number155401-1205
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: