DR. GREGORY L STAKER (NPI# 1275593717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275593717 |
| Entity Type | Individual |
| Full Name | DR. GREGORY L STAKER |
| Credential | MD |
| Practice Address |
210 W 300 N 75-3 Roosevelt UT 84066 |
| Practice Telephone | 4357223971 |
| Practice Fax Number | 4357226104 |
| Mailing Telephone | 4357223971 |
| Mailing Fax Number | 4357226104 |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2017-06-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 49110821205 | UT | Allopathic & Osteopathic Physicians |
| Y | 208000000X | Pediatrics | 49110821205 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | D3854 | 05 | |
| UT | MEDICARE GROUP PIN | 000006166 | 01 |
| Street Address |
210 W 300 N 75-3 |
| City | ROOSEVELT |
| State | UT |
| Zip Code | 84066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861452070 | Michael D Catten | Otolaryngology | 210 W 300 N 75-3, Roosevelt, UT 84066 | 2006-03-23 |
| 1316908122 | James D White | Physical Medicine & Rehabilitation | 210 W 300 N 75-3, Roosevelt, UT 84066 | 2006-03-31 |
| 1083675649 | Lori A Teem | Nurse Practitioner | 210 W 300 N 75-3, Roosevelt, UT 84066 | 2006-03-31 |
| 1912968538 | Bradley F Jenkins | Nurse Practitioner | 210 W 300 N 75-3, Roosevelt, UT 84066 | 2006-03-31 |
| 1194786095 | John D Nolte | Obstetrics & Gynecology | 210 W 300 N 75-3, Roosevelt, UT 84066 | 2006-03-30 |
| 1750342655 | Shane K Powell | Ophthalmology | 210 W 300 N 75-3, Roosevelt, UT 84066 | 2006-03-30 |
| 1023079910 | Darwin L Mckee | Physician Assistant | 210 W 300 N 75-3, Roosevelt, UT 84066 | 2006-03-30 |
| 1023078045 | Shannon R Staker | Pediatrics | 210 W 300 N 75-3, Roosevelt, UT 84066 | 2006-03-24 |
| 1497715593 | Lawrence Lynn Morrill | Emergency Medicine | 210 W 300 N 75-3, Roosevelt, UT 84066 | 2006-03-24 |
| 1891755872 | Jason S Beales | Pediatrics | 210 W 300 N 75-3, Roosevelt, UT 84066 | 2006-03-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477075315 | Annemarie Rousseau | Registered Nurse | 250 West 300 North, Roosevelt, UT 84066 | 2017-07-12 |
| 1780036772 | Drew Gilley | Dentist | 375 E Lagoon St, Roosevelt, Ut 84066, Roosevelt, UT 84066 | 2016-07-01 |
| 1952758039 | Amanda Adams | Massage Therapist | 1151 East Hwy 40, Ballard, UT 84066 | 2016-05-19 |
| 1447624325 | Gregory George Page | Dentist | 209 West 200 North 71-2, Roosevelt, UT 84066 | 2015-11-16 |
| 1659785772 | Becky Ann Birch | Nurse Practitioner | 200 West 350 North, Ste 103, Roosevelt, UT 84066 | 2014-06-17 |
| 1760724280 | Novo Ranch LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3549 W 1000 North, Roosevelt, UT 84066 | 2013-03-22 |
| 1508110040 | Uintah Basin Spine and Disc Center, PC | Rehabilitation Unit | 1151 East Highway 40, Roosevelt, UT 84066 | 2012-11-06 |
| 1184918682 | Alvaro Beltran | Dentist | Ave. Lopez Mateos 171-4, Nogales, SONORA 84066 | 2011-06-02 |
| 1255638367 | Cosme Cantu | Dentist | Blvd. El Greco #45 Int. J-14, Nogales, SONORA 84066 | 2011-02-25 |
| 1740482009 | Northeastern Utah Medical Group | Durable Medical Equipment & Medical Supplies | 210 W 300 N 75 3, Roosevelt, UT 84066 | 2007-05-31 |
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| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023078045 | Shannon R Staker | Pediatrics | 210 W 300 N 75-3, Roosevelt, UT 84066 | 2006-03-24 |
| 1891755872 | Jason S Beales | Pediatrics | 210 W 300 N 75-3, Roosevelt, UT 84066 | 2006-03-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205448057 | Puzzle Pediatrics LLC | Pediatrics | 230 N Hospital Dr Ste 3, Price, UT 84501-4222 | 2020-08-21 |
| 1619430303 | Hailey N. Baisch | Pediatrics | 81 N Mario Capecchi Dr Rm 1a.001, Salt Lake City, UT 84113-1125 | 2019-04-09 |
| 1184184632 | Abbey Jo Bentley | Pediatrics | 1248 E 90 N Ste 202, American Fork, UT 84003-2959 | 2019-03-21 |
| 1114487717 | Heber Valley Medical LLC | Pediatrics | 380 E 1500 S Ste 201, Heber City, UT 84032-3942 | 2019-03-21 |
| 1689180218 | Ihc Health Services Inc | Pediatrics | 395 W Bulldog Blvd Ste 703, Provo, UT 84604 | 2017-12-19 |
| 1811415565 | Community Health Centers, Inc. | Pediatrics | 324 Tenth Ave Ste 249, Salt Lake City, UT 84103-2889 | 2017-09-01 |
| 1124548805 | Joshua Brent Maxwell | Pediatrics | 8822 S Redwood Rd Ste C211, West Jordan, UT 84088-9340 | 2017-06-22 |
| 1083145445 | Landon Robert Hendricks | Pediatrics | 848 N 980 W, Orem, UT 84057-7709 | 2017-03-27 |
| 1902349657 | Kelson Physician Partner's of Layton, Inc. | Pediatrics | 5286 S. 3500 W., Suite A, Roy, UT 84067 | 2016-11-29 |
| 1134672074 | Robert Jarrett | Pediatrics | 12669 S Toscana Way, Herriman, UT 84096-4866 | 2016-07-27 |
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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.