Healthcare Provider Details

I. General information

NPI: 1376846121
Provider Name (Legal Business Name): STUART W. KING, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 E 1200 S
OREM UT
84097-6603
US

IV. Provider business mailing address

PO BOX 970188
OREM UT
84097-0188
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-0891
  • Fax: 801-224-7100
Mailing address:
  • Phone: 801-224-0891
  • Fax: 801-224-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STUART WESLEY KING
Title or Position: OWNER
Credential: M.D.
Phone: 801-224-0891