Healthcare Provider Details

I. General information

NPI: 1750554838
Provider Name (Legal Business Name): STANLEY J PHILLIPS DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9690 S 1300 E STE 120
SANDY UT
84094-3798
US

IV. Provider business mailing address

9690 S 1300 E STE 120
SANDY UT
84094-3721
US

V. Phone/Fax

Practice location:
  • Phone: 801-501-4335
  • Fax: 801-501-4338
Mailing address:
  • Phone: 801-501-4335
  • Fax: 801-501-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number27973660501
License Number StateUT

VIII. Authorized Official

Name: STANLEY J PHILLIPS
Title or Position: PC
Credential: DPM
Phone: 801-501-4335