=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841202397
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STANLEY J PHILLIPS DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2006
-----------------------------------------------------
Last Update Date | 02/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1184 E 80 N
-----------------------------------------------------
City | AMERICAN FORK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84003-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-763-3885
-----------------------------------------------------
Fax | 801-763-3887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 157 N 400 W # B7
-----------------------------------------------------
City | OREM
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84057-1909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-763-3885
-----------------------------------------------------
Fax | 801-763-3887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 27973660501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------