Provider Demographics
NPI:1477556298
Name:SCHIFFGEN, STEPHEN THOMAS (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:THOMAS
Last Name:SCHIFFGEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9690 S 1300 E
Mailing Address - Street 2:# 120
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3721
Mailing Address - Country:US
Mailing Address - Phone:801-501-4335
Mailing Address - Fax:801-501-4338
Practice Address - Street 1:9690 S 1300 E
Practice Address - Street 2:# 120
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3721
Practice Address - Country:US
Practice Address - Phone:801-501-4335
Practice Address - Fax:801-501-4338
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT102865-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012541Medicare PIN
UT1104990001Medicare NSC
UTT77941Medicare UPIN