Provider Demographics
NPI:1578737979
Name:KIRK, STEPHEN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:THOMAS
Last Name:KIRK
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 1:9350 S 150 E
Mailing Address - Street 2:SUITE 460
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2702
Mailing Address - Country:US
Mailing Address - Phone:801-858-3715
Mailing Address - Fax:
Practice Address - Street 1:1490 E FOREMASTER DR STE 150
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4495
Practice Address - Country:US
Practice Address - Phone:435-628-9393
Practice Address - Fax:435-628-9382
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7397691-1205207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine