# STACEY BANK MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134206311
- **Authorized official:** STACEY BANK MD (PRESDENT)
- **Authorized official phone:** (801) 892-0135

## Contact information

- **Practice address:** 1151 E 3900 S, STE B299, SALT LAKE CITY, UT 84124-1216
- **Practice address phone:** (801) 892-0135
- **Practice address fax:** (801) 266-2362
- **Mailing address:** 1151 E 3900 S, STE B299, SALT LAKE CITY, UT 84124-1216
- **Mailing address phone:** (801) 892-0135
- **Mailing address fax:** (801) 266-2362

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 53919971205 | UT | Yes |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 08/22/2020