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General NPI Number Information
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NPI Number | 1285453423
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Entity Type | Individual
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Provider Name | ANDREW STOVER PA
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Gender | Male
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 50 N MEDICAL DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-9004
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Country | US
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Telephone | 801-581-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 13808 TEAL CREEK DR
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City | BROOMFIELD
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State | CO
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Zip | 80023-3979
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Country | US
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Telephone | 303-903-8205
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 14189932-1206
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License Number State | UT
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