Healthcare Provider Details

I. General information

NPI: 1568039246
Provider Name (Legal Business Name): ERIC STAPLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6112 S 1550 E
OGDEN UT
84405-5007
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-3800
  • Fax: 801-475-3801
Mailing address:
  • Phone: 801-475-3500
  • Fax: 801-475-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14265125-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: