Individual
MS. STACY ANN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
170 NORTH 1100 EAST, AMERICAN FORK, UT 84003
(801) 714-6570
Mailing address
PO BOX 430, SPANISH FORK, UT 84660-0430
(866) 898-7136
(616) 975-9827
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
EMTL-2020-001
GU
207P00000X
Emergency Medicine Physician
M-2221
GU
207P00000X
Emergency Medicine Physician
MTL-2018-027
GU
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
341513
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107008020102
SELECT HEALTH
UT
01
—
491910
DESERET MUTUAL
UT
01
—
870636000MA1
EDUCATORS MUTUAL
UT
01
—
97341513101001
BCBS
UT
05
—
D2015
—
UT
Enumeration date
05/18/2006
Last updated
04/09/2021
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