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Individual
STANLEY DWAYNE ROBERTS
Active
Individual
STANLEY DWAYNE ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
276489
UT
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
276489-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107018542102
SELECT HEALTH
UT
01
—
174069
DESERET MUTUAL
UT
01
—
52892628603001
BCBS
—
01
—
87148
PEHP
UT
05
—
D1423
—
UT
01
—
P00221212
RAILROAD MEDICARE
—
Enumeration date
05/26/2006
Last updated
05/09/2012
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