Organization
GAVIN VAN STADEN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAVIN VAN STADEN MD (DR)
(801) 201-2771
Entity
Organization
Contact information
Practice address
3263 S HIGHWAY 89, STE 300, BOUNTIFUL, UT 84010-8555
(801) 296-0600
Mailing address
3263 S HIGHWAY 89, STE 300, BOUNTIFUL, UT 84010-8555
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
5863514-1205
UT
Other
Enumeration date
08/03/2011
Last updated
08/03/2011
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