MEDICARE: GARY NEIL STOKES M.D

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	2083P0901X	Public Health & General Preventive Medicine Physician	10119882-1205	UT
2	207R00000X	Internal Medicine Physician	0119882-8905	UT

General Provider Information

NPI Number	:	1578553210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY NEIL STOKES M.D

Provider Business Mailing Address
First Line	:	655 EAST 1300 NORTH
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84341
Country	:	US
Telephone Number	:	435-792-6500
Fax Number	:	435-792-6608

Provider Business Practice Location Address
First Line	:	655 EAST 1300 NORTH
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84341
Country	:	US
Telephone Number	:	435-792-6500
Fax Number	:	435-792-6608

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	02/21/2017

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