Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 4948143-4201 | UT |
NPI | 1053312744 |
---|---|
Provider Name | Paige Stotts |
First Address | Salt Lake City, UT 84117-6657 |
Second Address | Salt Lake City, UT 84117-6601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1108540001 | CIGNA DMERC (01) | UT |
49481434202001 | BLUE CROSS BLUE SHIELD (01) | UT |
5417 | DMBA (01) | UT |
64-00523 | UNITED HEALTHCARE (01) | UT |
83015 | PEHP (01) | UT |
870388269BR1 | EDUCATORS MUTUAL (01) | UT |
CJ9402 | RAILROAD MEDICARE (01) | UT |