Basic Information
| Provider Information | |||||||||
| NPI: | 1003869421 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEMENTS | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | P.A.-C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5810 S 300 E | ||||||||
| Address2: | SUITE300 | ||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841076178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013142225 | ||||||||
| FaxNumber: | 8013142345 | ||||||||
| Practice Location | |||||||||
| Address1: | 5810 S 300 E | ||||||||
| Address2: | SUITE300 | ||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841076178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013142225 | ||||||||
| FaxNumber: | 8013142345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 5972740-8906 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.