Organization
STAT-MD I
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN KNEPPER (OWNER)
(435) 604-0160
Entity
Organization
Contact information
Practice address
1784 UINTA WAY UNIT E2, PARK CITY, UT 84098-7685
(435) 604-0160
(435) 731-8328
Mailing address
PO BOX 981630, PARK CITY, UT 84098-1630
(435) 604-0160
(435) 604-0160
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
10/01/2019
Last updated
10/01/2019
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