Basic Information
| Provider Information | |||||||||
| NPI: | 1487627691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALLISTER | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2437 E 3510 S | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841093480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012727734 | ||||||||
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| Practice Location | |||||||||
| Address1: | BUILDING 400 | ||||||||
| Address2: | TOOELE ARMY DEPOT | ||||||||
| City: | TOOELE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4358332572 | ||||||||
| FaxNumber: | 4358333933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 157295-1205 | UT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.