Organization
STACEY BANK MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY BANK MD (PRESDENT)
(801) 892-0135
Entity
Organization
Contact information
Practice address
1151 E 3900 S, STE B299, SALT LAKE CITY, UT 84124-1216
(801) 892-0135
(801) 266-2362
Mailing address
1151 E 3900 S, STE B299, SALT LAKE CITY, UT 84124-1216
(801) 892-0135
(801) 266-2362
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
53919971205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03061975
BIRTHDATE OF OWNER
UT
Enumeration date
11/01/2006
Last updated
08/22/2020
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