Individual
DR. GREGORY L STAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
210 W 300 N 75-3, ROOSEVELT, UT 84066
(435) 722-3971
(435) 722-6104
Mailing address
210 W 300 N 75-3, ROOSEVELT, UT 84066
(435) 722-3971
(435) 722-6104
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
49110821205
UT
208000000X
Pediatrics Physician
Primary
49110821205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000006166
MEDICARE GROUP PIN
UT
05
—
D3854
—
UT
Enumeration date
03/27/2006
Last updated
06/28/2017
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