Provider Demographics
NPI:1831359298
Name:DALE G STOTT MD PC
Entity type:Organization
Organization Name:DALE G STOTT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:STOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-688-7246
Mailing Address - Street 1:301 N 200 E
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3010
Mailing Address - Country:US
Mailing Address - Phone:435-688-7246
Mailing Address - Fax:435-688-1363
Practice Address - Street 1:301 N 200 E
Practice Address - Street 2:SUITE 2A
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3010
Practice Address - Country:US
Practice Address - Phone:435-688-7246
Practice Address - Fax:435-688-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59125901205207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE85891Medicare UPIN