Provider Demographics
NPI:1497930200
Name:STANTON MCDONALD, MD PC
Entity Type:Organization
Organization Name:STANTON MCDONALD, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-654-1501
Mailing Address - Street 1:345 W 600 S STE 120
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-2283
Mailing Address - Country:US
Mailing Address - Phone:435-654-1501
Mailing Address - Fax:435-654-2030
Practice Address - Street 1:345 W 600 S STE 120
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-2283
Practice Address - Country:US
Practice Address - Phone:435-654-1501
Practice Address - Fax:435-654-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT160908-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529741935038Medicaid
UTD07293Medicare UPIN