Provider Demographics
NPI:1962442822
Name:ROYALL, STEVEN PAUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PAUL
Last Name:ROYALL
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 1:617 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-1901
Mailing Address - Country:US
Mailing Address - Phone:801-262-1172
Mailing Address - Fax:801-266-3401
Practice Address - Street 1:617 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1901
Practice Address - Country:US
Practice Address - Phone:801-262-1172
Practice Address - Fax:801-266-3401
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1065420501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000010526Medicare ID - Type Unspecified
U32716Medicare UPIN