Healthcare Provider Details

I. General information

NPI: 1265990329
Provider Name (Legal Business Name): STEPS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S OREM BLVD
OREM UT
84058-5011
US

IV. Provider business mailing address

996 W 800 S
PAYSON UT
84651-2766
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-5111
  • Fax:
Mailing address:
  • Phone: 801-465-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JEREMIAH GOLESH
Title or Position: DIRECTOR
Credential:
Phone: 801-455-2687