Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 8791004-1205 | UT |
NPI | 1003174129 |
---|---|
Provider Name | Stephen Craig Merrell |
First Address | Layton, UT 84041-0337 |
Second Address | Roy, UT 84067-9103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2012 |
Last Update Date | 16/03/2020 |