Provider Demographics
NPI:1164421053
Name:STOTT, DALE GERALD (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:GERALD
Last Name:STOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N 200 E
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3010
Mailing Address - Country:US
Mailing Address - Phone:435-688-7246
Mailing Address - Fax:435-688-1363
Practice Address - Street 1:301 N 200 E
Practice Address - Street 2:SUITE 2A
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3010
Practice Address - Country:US
Practice Address - Phone:435-688-7246
Practice Address - Fax:435-688-1363
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT361711-1205207LP2900X
NV8751207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012062Medicare ID - Type Unspecified
UTE85891Medicare UPIN