Provider Demographics
NPI:1275681686
Name:STOCK, CURT ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:CURT
Middle Name:ROBERT
Last Name:STOCK
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:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-295-5581
Mailing Address - Fax:801-295-9253
Practice Address - Street 1:1551 RENAISSANCE TOWNE DR
Practice Address - Street 2:SUITE 310
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7667
Practice Address - Country:US
Practice Address - Phone:801-295-5581
Practice Address - Fax:801-295-9253
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT188579-1205207Y00000X
WY5395A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY108555700Medicaid
WY108555700Medicaid
UTP00061070Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WY20255Medicare PIN
UT005746001Medicare PIN