Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 172322-1205 | UT |
Y | 213ES0000X | Sports Medicine | 172322-1205 | UT |
NPI | 1497026330 |
---|---|
Provider Name | Dr. Earl Warren Stadler JR. |
First Address | Park City, UT 84068-1599 |
Second Address | Park City, UT 84060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2012 |
Last Update Date | 24/01/2012 |