Provider Demographics
NPI:1366497166
Name:HEATH, STEVEN W (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:W
Last Name:HEATH
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 1:4624 HOLLADAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5206
Mailing Address - Country:US
Mailing Address - Phone:801-277-2682
Mailing Address - Fax:801-277-2980
Practice Address - Street 1:4624 HOLLADAY BLVD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5206
Practice Address - Country:US
Practice Address - Phone:801-277-2682
Practice Address - Fax:801-277-2980
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT90-182716-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE47395Medicare UPIN
U000000385Medicare PIN