Provider Demographics
NPI:1790891430
Name:DESAUTELS, STEVEN GREGG (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GREGG
Last Name:DESAUTELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1393 E SEGO LILY DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4350
Mailing Address - Country:US
Mailing Address - Phone:801-619-9000
Mailing Address - Fax:801-619-9001
Practice Address - Street 1:1393 E SEGO LILY DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-4350
Practice Address - Country:US
Practice Address - Phone:801-619-9000
Practice Address - Fax:801-619-9001
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT185072-1205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1790891430OtherNPI
F65575Medicare UPIN
UTF65575Medicare UPIN