Provider Demographics
NPI:1184630071
Name:SINGER, STEPHANIE M (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:SINGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 W. UTE BLVD.
Mailing Address - Street 2:SUITE 160
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098
Mailing Address - Country:US
Mailing Address - Phone:435-214-5335
Mailing Address - Fax:435-214-5340
Practice Address - Street 1:1441 W. UTE BLVD.
Practice Address - Street 2:SUITE 160
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098
Practice Address - Country:US
Practice Address - Phone:435-214-5335
Practice Address - Fax:435-214-5340
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4894125-1204174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005578911Medicare ID - Type Unspecified
UTG55628Medicare UPIN