Roberts, Stanley Dwayne

Roberts, Stanley Dwayne is an individual health care provider with primary practice located at 118 N Main St Ste B, Salem UT 84653-5698. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medical Services, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Roberts, Stanley Dwayne can be contacted via phone (801) 477-9007.

Contact Information

Primary practice address
118 N Main St Ste B Salem UT 84653-5698
Phone: (801) 477-9007
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X 276489 Utah
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 276489-1205 Utah

Profile Details

NPI number 1316993520
LBN Legal business name Roberts, Stanley Dwayne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 26th, 2006
Last updated May 9th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316993520 NPPES
Utah Other 107018542102 SELECT HEALTH
Utah Other 174069 SELECT HEALTH
Utah Other 87148 SELECT HEALTH
Utah Other 52892628603001 SELECT HEALTH
Utah MEDICAID D1423 SELECT HEALTH
Utah Other P00221212 SELECT HEALTH

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