Healthcare Provider Details

I. General information

NPI: 1578737979
Provider Name (Legal Business Name): STEPHEN THOMAS KIRK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E MALL DR
ST GEORGE UT
84790-1954
US

IV. Provider business mailing address

1055 N 500 W ATTN CREDENTIALING
PROVO UT
84604
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-9393
  • Fax: 435-628-9382
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number7397691-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: