Provider Demographics
NPI:1275688228
Name:STRATFORD, C. KERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:C.
Middle Name:KERRY
Last Name:STRATFORD
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 1:1055 N 500 W
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:736 S 900 E STE 203
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7003
Practice Address - Country:US
Practice Address - Phone:435-673-6131
Practice Address - Fax:435-673-8557
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1745291205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT08443Medicaid
UT000005497Medicare ID - Type Unspecified
UTD07864Medicare UPIN