Provider Demographics
NPI:1780671107
Name:VAN NORMAN, STEVEN ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALLAN
Last Name:VAN NORMAN
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:PO BOX 30180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:435-251-1000
Mailing Address - Fax:435-688-5514
Practice Address - Street 1:1380 E MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2123
Practice Address - Country:US
Practice Address - Phone:435-251-1000
Practice Address - Fax:435-688-5514
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT169830-8905207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002089501Medicaid
UT07438Medicaid
AZ317330Medicaid
D87749Medicare UPIN
006456002Medicare ID - Type Unspecified
AZ317330Medicaid