Provider Demographics
NPI:1578585212
Name:MONCRIEF, STEVEN DOUGLAS (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:MONCRIEF
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-507-3400
Mailing Address - Fax:801-507-3425
Practice Address - Street 1:5169 COTTONWOOD ST
Practice Address - Street 2:SUITE 420
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6767
Practice Address - Country:US
Practice Address - Phone:801-507-3400
Practice Address - Fax:801-507-3425
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT105007-1206363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS43074Medicare UPIN
UT000059385Medicare PIN