Individual
GERALD B STEPHANZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 N 500 W, PROVO, UT 84604-3305
(801) 377-4623
(801) 377-6832
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(801) 354-8225
(801) 429-8180
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
2743691205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107006986101
IHC
UT
01
—
124890
DMBA
UT
01
—
31-0041
UNITED HEALTHCARE
UT
01
—
62051
PEHP
UT
05
—
870281028000
—
UT
01
—
870281028ST2
EMIA
UT
01
—
QM0000044589
ALTIUS
UT
Enumeration date
07/01/2006
Last updated
11/01/2007
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