Healthcare Provider Details

I. General information

NPI: 1235426925
Provider Name (Legal Business Name): STEVEN E WARREN MD PC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4698 S HIGHLAND DR STE 100
SLC UT
84117-5176
US

IV. Provider business mailing address

4698 S HIGHLAND DR STE 100
SLC UT
84117-5176
US

V. Phone/Fax

Practice location:
  • Phone: 801-797-5901
  • Fax: 801-797-5906
Mailing address:
  • Phone: 801-797-5901
  • Fax: 801-797-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN E WARREN
Title or Position: OWNER
Credential: MD
Phone: 801-652-8613