Provider Demographics
NPI:1265728927
Name:HILLAM, STEVEN JON (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:JON
Last Name:HILLAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E 100 N STE 125
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1638
Mailing Address - Country:US
Mailing Address - Phone:801-658-5486
Mailing Address - Fax:
Practice Address - Street 1:910 E 100 N STE 125
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1638
Practice Address - Country:US
Practice Address - Phone:801-658-5486
Practice Address - Fax:801-658-5496
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1979-16207W00000X
CO0055146207W00000X
UT12199013-1204207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology