Individual
ALBERT SIMON STONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
210 W 300 N, ROOSEVELT, UT 84066-2336
(435) 722-4691
Mailing address
210 N 300 W, ROOSEVELT, UT 84066-2334
(435) 724-2059
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9045633-1206
UTAH DEPARTMENT OF OCCUPATIONAL AND PROFESSIONAL LICENSING - PA STATE LICENSE
UT
01
—
9045633-8906
UTAH DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING - CONTROLLED SUBSTANCE
UT
Enumeration date
08/23/2018
Last updated
09/12/2018
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