Healthcare Provider Details

I. General information

NPI: 1932242690
Provider Name (Legal Business Name): STANLEY MORRIS GARDNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10946 S HYRUM PL SUITE 317
SANDY UT
84070-5202
US

IV. Provider business mailing address

10946 S HYRUM PL
SANDY UT
84070-5202
US

V. Phone/Fax

Practice location:
  • Phone: 801-302-5397
  • Fax: 801-254-0273
Mailing address:
  • Phone: 801-302-5397
  • Fax: 801-254-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number166258-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: