1871622985 NPI number — DR. WAYNE L STOKES MD

Table of content: DR. WAYNE L STOKES MD (NPI 1871622985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871622985 NPI number — DR. WAYNE L STOKES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOKES
Provider First Name:
WAYNE
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871622985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 510708
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84151-0708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-587-6600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1743 REDSTONE CENTER DR
Provider Second Line Business Practice Location Address:
STE. 115
Provider Business Practice Location Address City Name:
PARK CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84098-7929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-658-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  5574948-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 807019600 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: D5827 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100506120 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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