Provider Demographics
NPI:1265439236
Name:DAY, STEFANI JANE (MD)
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:JANE
Last Name:DAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEFANI
Other - Middle Name:J
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1665 BONANZA DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-5127
Mailing Address - Country:US
Mailing Address - Phone:435-649-7640
Mailing Address - Fax:435-645-7768
Practice Address - Street 1:1665 BONANZA DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-5127
Practice Address - Country:US
Practice Address - Phone:435-649-7640
Practice Address - Fax:435-645-7768
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT376416-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH39379Medicare UPIN