Provider Demographics
NPI:1720034416
Name:PLUNKETT, STEPHANIE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 W 9800 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4713
Mailing Address - Country:US
Mailing Address - Phone:801-433-2873
Mailing Address - Fax:801-433-5734
Practice Address - Street 1:1868 W 9800 S
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4713
Practice Address - Country:US
Practice Address - Phone:801-433-2873
Practice Address - Fax:801-433-5734
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5212615-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5212615-1205OtherSTATE LICENSE NUMBER
UT5212615-1205OtherSTATE LICENSE NUMBER
UTBP5910294OtherDEA NUMBER
UT005771403Medicare PIN