Individual
RYAN J STOLWORTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 N 500 E, LOGAN, UT 84341
(435) 716-1000
Mailing address
PO BOX 25535, SALT LAKE CITY, UT 84125
(866) 898-7136
(616) 975-9824
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
5110139
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51101391200001
BCBS
—
05
—
D4636
—
UT
01
—
P00000456
RAILROAD MEDICARE
—
Enumeration date
07/10/2006
Last updated
11/15/2007
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