Individual
STANLEY DWAYNE ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
118 N MAIN ST, STE B, SALEM, UT 84653-5698
(801) 477-9007
Mailing address
PO BOX 10, SPANISH FORK, UT 84660-0010
(866) 898-7136
(616) 975-9824
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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