Provider Demographics
NPI:1841202397
Name:PHILLIPS, STANLEY J (DPM)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:J
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 N 400 W # B7
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-1909
Mailing Address - Country:US
Mailing Address - Phone:801-763-3885
Mailing Address - Fax:801-763-3887
Practice Address - Street 1:1184 E 80 N
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2906
Practice Address - Country:US
Practice Address - Phone:801-763-3885
Practice Address - Fax:801-763-3887
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT27973660501213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005819102OtherMEDICARE PIN FOR FOOT & ANKLE CLINIC
UT203620216001Medicaid
UT000012317Medicare PIN