Healthcare Provider Details

I. General information

NPI: 1164421053
Provider Name (Legal Business Name): DALE GERALD STOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 200 E SUITE 2A
ST GEORGE UT
84770-3010
US

IV. Provider business mailing address

301 N 200 E SUITE 2A
ST GEORGE UT
84770-3010
US

V. Phone/Fax

Practice location:
  • Phone: 435-688-7246
  • Fax: 435-688-1363
Mailing address:
  • Phone: 435-688-7246
  • Fax: 435-688-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number361711-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number8751
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: