MEDICARE: DR. SCOTT M STEVENS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	3222041205	UT

General Provider Information

NPI Number	:	1336169788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT M STEVENS MD

Provider Business Mailing Address
First Line	:	5169 S COTTONWOOD ST STE 300
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-6768
Country	:	US
Telephone Number	:	801-507-3747
Fax Number	:	801-507-3350

Provider Business Practice Location Address
First Line	:	5169 S COTTONWOOD ST STE 300
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-6768
Country	:	US
Telephone Number	:	801-507-3747
Fax Number	:	801-507-3350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	04/22/2019

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