JACK EDWARD STEPHENS (NPI# 1073991915) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073991915 |
| Entity Type | Individual |
| Full Name | JACK EDWARD STEPHENS |
| Credential | M.D. |
| Practice Address |
4401 Harrison Blvd Ogden UT 84403 |
| Mailing Address |
6140 Sharon Cir Ogden UT 84403-5008 |
| Practice Telephone | 8013873709 |
| Practice Fax Number | 8013873725 |
| Mailing Telephone | 4359012735 |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2018-06-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 10476493-8905 | UT | Allopathic & Osteopathic Physicians |
| Y | 207R00000X | Internal Medicine | 10476493-1205 | UT | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | R74955 | AZ | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700200680 | Jack Stephens | Psychologist | 801 Old Harshman Rd, Riverside, OH 45431-1238 | 2014-02-12 |
| 1366607772 | Jack Stephens | Dentist | 6315 Cypresswood Dr, Spring, TX 77379-8208 | 2008-07-24 |
| Street Address |
4401 HARRISON BLVD |
| City | OGDEN |
| State | UT |
| Zip Code | 84403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538142922 | Paul S Thorpe | Pathology | 4401 Harrison Blvd, Ogden, UT 84403-3195 | 2005-11-21 |
| 1578172904 | Justin Richard Degooyer | Registered Nurse | 4401 Harrison Blvd, Ogden, UT 84403-3195 | 2020-07-31 |
| 1730707795 | Caitlin Karissa Taggart | Dietitian, Registered | 4401 Harrison Blvd, Ogden, UT 84403-3195 | 2020-07-07 |
| 1760006324 | Rachel Michelle Wright | Registered Nurse | 4401 Harrison Blvd, Ogden, UT 84403-3195 | 2020-05-29 |
| 1528688264 | Mckenna Kelly Vance | Registered Nurse | 4401 Harrison Blvd, Ogden, UT 84403-3195 | 2020-04-22 |
| 1073133252 | Carole Lomax | Dietitian, Registered | 4401 Harrison Blvd, Ogden, UT 84403-3195 | 2020-04-17 |
| 1821618000 | Tami Greaves Halford | Registered Nurse | 4401 Harrison Blvd, Ogden, UT 84403-3195 | 2020-04-17 |
| 1356988695 | Elizabeth A Hafen | Speech-Language Pathologist | 4401 Harrison Blvd, Ogden, UT 84403-3195 | 2019-12-05 |
| 1902441835 | Courtney Mcdonald | Occupational Therapist | 4401 Harrison Blvd, Ogden, UT 84403-3195 | 2019-11-14 |
| 1275178238 | Philip Hahn Gainer | Occupational Therapist | 4401 Harrison Blvd, Ogden, UT 84403-3195 | 2019-11-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235744632 | Megan Louise Larkins | Specialist/Technologist | 4000 Brinker Ave. The Apartments., Apartment 15, Ogden, UT 84403 | 2020-09-11 |
| 1154959062 | Joshua Clifford Hansen | Student in an Organized Health Care Education/Training Program | 4403 Harrison Boulevard, Ste A700, Ogden, UT 84403 | 2020-03-28 |
| 1346895935 | Positional Release Therapy Institute LLC | Specialist/Technologist | 1702 E. 5600 S., Ogden, UT 84403 | 2019-08-09 |
| 1841842077 | Braken Wooden | Chiropractor | 1893 Skyline Dr., Suite 204, South Ogden, UT 84403 | 2019-07-09 |
| 1023670569 | Wasatch Advanced Dental Care LLC | Dentist | 3590 Harrison Blvd Suite #1, Ogden, UT 84403 | 2019-07-05 |
| 1194237636 | Marci Niemeyer | Physician Assistant | 5929 Fashion Point Dr Ste 101, South Ogden, UT 84403 | 2017-10-24 |
| 1578081949 | Stephanie Jensen | Specialist/Technologist | 1473 36th Street, Ogden, UT 84403 | 2017-09-06 |
| 1891213385 | Forrest Sutherland | Specialist/Technologist | 1075 E 41st St., Ogden, UT 84403 | 2017-09-05 |
| 1184159022 | Nicole Lee Van Tassell | In Home Supportive Care | 1496 East 5600 South, Unit 6, Ogden, UT 84403 | 2017-04-28 |
| 1265889166 | Modern Dental Professionals Ut, PC | Dentist | 5974 S. Fashion Pointe Drive, Suite 210, South Ogden, UT 84403 | 2016-05-20 |
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| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639797509 | Ihc Health Services Inc | Internal Medicine | 4387 Harrison Blvd Ste C1, Ogden, UT 84403-3148 | 2020-07-08 |
| 1942610993 | Nickolas Gangwer | Internal Medicine | 4403 Harrison Blvd Ste 3875, Ogden, UT 84403-3332 | 2014-04-29 |
| 1235491994 | Jesse Scott Swift | Internal Medicine | 2473 Woodland Dr, Ogden, UT 84403-5129 | 2012-06-08 |
| 1225355118 | Amce Physicians Group | Internal Medicine | 205 26th St, Suite 14, Ogden, UT 84401-3119 | 2010-04-30 |
| 1821236035 | Walter Evan Brodis | Internal Medicine | 2041 E 6025 S, Ogden, UT 84403-5270 | 2009-01-26 |
| 1265559595 | Shawn David Mcquilkin | Internal Medicine | Wsu Student Health Center, 1128 University Circle, Ogden, UT 84408-1128 | 2007-03-23 |
| 1689771362 | Gilbert E Caillouet Jr. | Internal Medicine | 1292 E 5375 S, Ogden, UT 84403-4544 | 2006-09-17 |
| 1851409544 | Seth R Lewis | Internal Medicine | 555 E 5350 S Ste 7, Ogden, UT 84405-4509 | 2006-08-25 |
| 1518988039 | Donna L Milavetz | Internal Medicine | 1976 Arapaho Cir, Ogden, UT 84403-4648 | 2006-07-21 |
| 1588689095 | John K Reis | Internal Medicine | 760 Holroyd Dr, Ogden, UT 84403-4511 | 2006-07-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.